Calcaneus cyst

For the first time the calcaneus cyst was described by the German physician Virchow in the late 19th century. Earlier the cyst was defined by multiple concepts - sinus calcaneus, intraosseous lipoma, chondroma, osteodystrophy of calcaneus. Until now, there are cases when even experienced doctors diagnose cysts of the heel as bursitis, although this is incorrect in the clinical and pathogenetic sense.

The heel bone is considered the main support of the foot, since calcaneus is the largest bone in the overall structure of the lower leg. It connects with the talus and cuboid bone and carries the main support load with the vertical position of the body, as well as walking.

The calcaneus consists of the body and the tubercle, the cystic tumor is most often localized in the body of os calcis, which is due to the peculiarities of the structure of the bone tissue and its capacity for intensive growth in certain age periods.

[1], [2], [3], [4], [5], [6], [7]

Symptoms of a calcaneus cyst

The main clinical signs of a benign tumor-like formation in the calcaneus:

• The destructive focus has a rounded shape.
• The destruction of bone tissue is clearly limited and separated from healthy tissues.
• The cyst is prone to slow development in an inactive form.
• The cortical layer is enlarged, its thinning is noticeable.
• Periodic reaction is absent.
• The tumor is defined as non-aggressive, less than 5-6 centimeters.

The inactive form of the calcaneus cyst proceeds asymptomatically and often disappears spontaneously as the skeleton forms. The active cysts are more aggressive, which manifest themselves in the form of painful sensations during walking and running, obvious swelling of the heel in the area of tumor development, transient lameness and discomfort when wearing shoes. Also, quite often there are micro-fractures that are unavoidable with a long course of the disease and a constant load on the foot.

Symptoms of a pathological fracture can also go unnoticed for quite a long time, especially if the patient is concerned about other bone pains - in the knee, in the hip joint. Pathological fracture of the bone can be accompanied by swelling of the foot, heel, the limitations of the motor activity with full preservation of the volume of movements in the ankle.

Bone calcaneal cyst

Osteodystrophic processes in calcaneus are mostly found in childhood, much less often the bone cyst of heel is diagnosed at a young age, it is possible in the presence of a permanent traumatic factor, for example, in professional sports. According to the statistics of ACC or CCM, only 1-1.5% of the total number of bone cysts detected in the heel bones is determined.

Bone cyst calcane, symptoms:

• Asymptomatic development of the cyst.
• The debut of clinical manifestations in adolescence.
• Pain in the heel when walking, running.
• Pain in the calcaneus when doing sports.
• Perhaps one-sided swelling of the foot in the place of development of the cyst.
• Pathological fracture, often recurrent and restricting movement.

As a diagnostic, in addition to external examination and palpation of the foot, an axial image, an X-ray, an ultrasound examination of the joint are shown, preferably a tomogram for the differentiation of osteodystrophic pathologies.

The bony cyst of the heel is rarely punctured, more often it is removed operatively, while filling the scraped cavity in parallel with a special biomaterial, allocostic composites.

In pathological fractures of the calcaneus cicatrix, the surgeon requires an important decision in choosing the method, method and timing of the operation:

1. Urgent, urgent surgery may be required if the patient is diagnosed with this condition:
   • Open fracture.
   • With a fracture, nerve endings and vessels are damaged, there are obvious symptoms of internal hematoma - compartment syndrome.
   • A comminuted fracture and a risk of pressure on the tissue from the side of the fragments.
2. Scheduled operation.

Refusal from surgical treatment and choice of conservative methods:

• The patient's age is less than 2-3 years and over 60 years.
• Fracture does not cause displacement of the joint.
• Medical contraindications for the operation (acute and severe chronic pathology of the cardiovascular system, and others).

The heel bone, complicated by a fracture, can be treated conservatively in this way:

• The first day - cold compresses.
• Elevated leg position for a week.
• Appointment of decongestants, analgesics.
• Imposition of the posterior longa for 5-7 days.
• Restriction of motor activity for a month.
• The use of walking crutches, sticks to reduce the axial load on the heel.
• Dynamic observation of the condition of the calcaneus bone within a half to two months using X-rays.

If the cyst of the heel bone is treated surgically, the recovery period can last from one year to one and a half years. This is due to the complex structure of the foot, the abundance of blood vessels in this zone, the risk of thrombosis and various osteopathology. A complication can also be the process of implanting the material used as a filling for the resection defect. The only way to prevent multiple risks of surgical intervention is timely diagnosis, a small bone cyst is much easier to cure by puncturing and after 4-6 months to restore the support function of the heel and foot.

[8], [9], [10], [11], [12], [13],

The calcaneal hepatic cyst

The foot is considered a rather complex anatomical part of the musculoskeletal system of the human body, since it consists of 26 bones, from which the calcaneus is the largest. It calcaneus provides a rigid support during movement, helps to maintain the weight of the human body. Statistics argue that the load on the heels increases 1.5 times with simple walking, and almost 3 times when running. This makes the heel bone vulnerable in principle, despite its strength in congenital anomalies of bone tissue insertion, it can be subjected to slow destruction and deformation.

A solitary cyst can develop in the heel bone from an early age, and this process sometimes lasts until the child reaches puberty, when significant changes occur throughout the body, including the hormonal and musculoskeletal system. Also, a solitary cyst in the calcaneus is diagnosed in children 5-7 years, more often in boys due to the rapid growth of the bone system. The factors that provoke the development of the heel cyst are still not specified, it is obvious that the process is based on degenerative-dystrophic changes of a benign nature that do not show signs of inflammation or blastomatous pathological changes. The musculoskeletal system is able to gradually recover, after lacunar resorption, the bone tissue changes over time due to metaplasia and a new formation of bone substance. Tumor growths in the calcaneus are relatively infrequent, since calcaneus is a short spongy bone, while for solitary bone cysts, localization is characteristic of long tubular bones. The calcaneus of the calcaneus is asymptomatic, often only its fracture can become a manifestating clinical manifestation and an excuse to call a doctor. Due to the fact that this type of cyst, despite the many published works, is still poorly understood, the diagnosis of a solitary cyst of the heel is often erroneous. The CCM is often defined as bursitis, chondroma, or osteoblastoclastoma. The difficulty of diagnosing is also due to the rather rare cases of SCC in the heel, the lack of clear criteria that help determine the bone cyst in this localization.

A simple solitary cyst of the calcaneus, uncomplicated fractures, is able to pass independently. The cause of periodic pain can be physical exertion, for example, running, playing sports. Sluggish symptoms persist for a long period, until the time when the stop completes the process of formation and growth. Complex situations, when the CCM is in an active phase and accompanied by a fracture, require surgical treatment and a fairly long recovery period. The cyst is removed, and the area where the resection was performed is filled with bone grafts. In most cases, the solitary cyst localized in the calcaneus bone is treated successfully and is not prone to recurrence, unlike the aneurysmal type of neoplasm, which can be multi-chambered and rather complicated in treatment.

Left calcaneal cyst

The tarsal calcaneus (Os calcis, calcaneus) is the largest part of the foot that enters the tarsal bone. Сalcaneus is responsible for the formation of the foot and carries out the supporting and spring functions. Periodic pain in the heel area is not only the patients themselves, but, unfortunately, doctors associate with the heel spur, bursitis. This is due to the complex structure of the foot, as well as to the fact that bone cysts in this zone are rare and poorly understood.

The left calcaneal cyst does not differ in pathogenesis from cystic neoplasms in the right heel. Most often the calcaneus cyst proceeds asymptomatically until it shows up as a pathological fracture. Conventional fractures of the calcaneus are an injury, which in 90% of cases occurs as a result of falling from a very high altitude. In contrast, stress fractures are rare, according to statistics, they do not exceed 10% of the total number of injuries of the tarsus. The pathological fracture of the heel foot is not accidentally called "marching", as it often happens in athletes or people who are in military service. Gradually developing cyst, localized mainly in the area between the process of the talus bone and the triangular bone, and also in the zone of Sesamum - Cessamiform small bones, causes pain during prolonged walking, and then a violation of the integrity of the calcaneus.

To find out whether the cyst of the left calcaneus bone can be helped only by a thorough and complex diagnosis, since in the topographic-anatomical sense the heel and foot as a whole does not separate from the ankle joint, it also needs to be inspected. Diagnostic methods that help to clarify the presence or absence of bone cyst:

• Radiography of the talus, calcaneus and ankle.
• The x-ray calcaneus in different projections, despite the pain symptom - is necessarily in the axial projection.
• Radiography of the anterior, middle foot zone in the oblique, lateral and plantar projection - with a direct magnification of the image.
• Computed tomography of the foot, including the ankle joint.

Treatment of a bony cyst complicated by a fracture of the calcaneus is always very difficult. The surgeon has to choose between numerous methods and determine the degree of risk of complications. If the computer tomogram shows a fracture of the upper part of the calcaneal tuberus that passes along the line of the upper wall of the cyst, an exochlearation of the tumor and a parallel filling of the cavity with an osteomaterial are carried out. Osteosynthesis can also be used with a special heel plate, closed reposition with fixation of the heel of the heel.

The duration of treatment and recovery period depends on the size, type of cyst and the severity of the fracture, and it takes from three months to one year.

Diagnosis of the calcaneus cyst

Practicing surgeons note that in 75% of the active calcaneus cyst is diagnosed in children under 10 years of age, then the intensity of resorption decreases, the cyst often collapses, closes, which coincides chronologically with the end of the process of formation of the musculoskeletal system of the child.

[14], [15], [16]

Treating the calcaneus cyst

The bony cyst in this zone most often develops without obvious clinical signs, so a person simply does not feel it, and accordingly does not treat. Treatment of the calcaneus cyst begins when there are periodic pain in walking, pathological fractures mainly in the zone of the subtalar joint.

The main method of treating the heel cyst is an operation in which the curettage of the cavity is carried out and then filled with a special plastic material. An extremely rarely complicated cyst requires subtotal resection or perforation of the bone in the cyst zone, followed by rinsing the cavity and filling it with an allocost material

Indications for surgical intervention in the diagnosis - the calcaneus cyst:

• Steady progression of symptoms and growth of the cyst.
• Explicit radiographic signs indicating an aggressive course of the disease.
• The risk of a pathological fracture confirmed by X-ray.
• Large cyst of heel, limiting motor activity.

Modern biocomposite materials allow not only to remove pain symptoms, but also to restore the osteogenesis and supporting-motor function of the entire lower limb almost completely.

Uncomplicated cysts of the heel in children are tried to treat with conservative methods, when the child is shown immobilization of the leg, bed rest. The cyst is punctured, if after one month of treatment it continues to increase, the tumor is removed by surgery. Exochleation of the tumor cavity with parallel filling of the defect with bone graft is carried out (allosolomka)

Also, a simple fracture is treated in a conservative way, the foot is immobilized with plaster gypsum, gypsum is applied from the knee to the tips of the toes. The leg is in plaster for at least 4 weeks, sometimes longer. After a certain period, the gypsum is removed, the radiograph of the foot is carried out. Usually the fracture helps to reduce the cavity of the cyst, it disappears, and the bone tissue is gradually restored. LFK, massage and physiotherapeutic procedures help to completely restore the normal support function of the foot, the recovery takes up to six months. If the fracture is accompanied by a displacement, which is often diagnosed with trauma in this area, even with a decrease in the size of the cyst, an operation is performed to restore the osteosynthesis with the Ilizarov apparatus and other intraosteal structures. Such methods are quite traumatic and carry the risk of complications, but they are considered to be the most effective in treating complex fractures. It should be noted that fractures with displacement are not characteristic of cystic bone dystrophy, but they are often diagnosed in the foot zone, which is explained by its complex structure, the presence of a multitude of small, vulnerable bones and the aggressive development of a cyst provoking destruction of tissues.

Unfortunately, treatment of calcaneus cyst in adult patients in most cases does not do without surgery, which is fraught with complications in the form of flat feet, bone deformation (protrusions) of posttraumatic nature. Prolonged and adequate therapy, including surgical intervention, helps to restore the support function of the heel and foot as a whole, provided that the doctor comes in timely when the first pain symptoms appear in the lower extremity.

Operation with calcaneus calcaneus

Operation of the calcaneus cyst is indicated in most cases, since the tumor in this zone is distinguished by an aggressive course, disrupting the normal blood supply of the foot, causing destruction of bone tissue and often immobilizing a person. The method of surgical treatment is determined by the possibility of access to the affected area, surgery for calcaneus is performed both under local anesthesia and under general anesthesia if a pathological fracture occurred or with a giant cyst. Before the operation, the surgeon should carefully study and take into account the following clinical symptoms: 

• The period of time in which the symptomatology occurred was a children's age of up to 10 years, puberty, age over 45 or 55 years.
• Duration of the course of the disease.
• The nature of the preceding operation of conservative treatment, if it was conducted.
• The volume of nearby soft tissues (in the area of suspected resection).
• Severity of impaired motor function and risks of postoperative immobilization.
• Condition of the skin of the foot, the state of the vascular system.
• Blood clotting level, risk of thrombosis.

Indications for the operation of the calcaneus cyst: 

• Lack of positive dynamics with conservative therapy for one and a half months.
• Progressive development, an increase in cysts.
• Pathological fracture of calcaneus with displacement.
• Fracture provoking joint discongrugency.
• Cysts of large size - more than 4-5 centimeters.

Criteria for choosing the method of surgical treatment are not standardized, the surgeon has to make a decision in accordance with the survey indicators and own practical experience. The most commonly used types of treatment are: 

• Exochleation, curettage with subsequent filling of the defect with filling alloplastic material, which helps to restore bone tissue. Subtotal resection of the cyst without the filling of the defect is accompanied by frequent relapses, according to statistics they are about 45-50%. 
• A cyst of a small size is not treated operatively, it is subject to dynamic observation, possibly repeated aspiration.
• The most common method of treating fractures is a closed reposition of the bone with the aid of an apparatus that fixes the bones of the foot (with a pathological fracture with displacement).

The choice of the method of surgical access is also a difficult task for the surgeon, since the operation itself is complex and can cause serious complications. Access can be: 

• External access, in which tissue is dissected up to the periosteum. This option requires virtuosic skill from the doctor, as there is a risk of damage to the perforating arteries, the surreal nerve and the sinews of the fibular muscle.
• Internal access is rarely used to diagnose a fragmented pathological fracture.

Operations for calcaneus calcaneus are considered complex, each type of operation has its pros and cons. Segmental or marginal resection, exochleation are all radical methods of treatment that are impossible without the use of grafts. Osteoplasty, replacing the bone defect, in turn carries the risk of rejection or suppuration of the tissues. Therefore, after the operation, it is very important to observe a strict regime of foot immobilization. This post-operation plan is recommended: 

• 3-5 days of stop is in an elevated position.
• Joints should be developed as soon as possible, on the 3rd day after the operation.
• Sutures are removed after 10-14 days.
• Within a month and a half, the patient is recommended walking with the help of crutches.
• Within 2-3 months, dynamic monitoring of bone and cysts is made using X-rays.
• The weight load can be resolved only 2 months after the operation.