A Case Report on the Treatment of Pediatric Aneurysmal Bone Cyst of the Calcaneus by Curettage and Allogeneic Bone Impaction Grafting: Long-Term Results
This case report details the successful long-term management of a rare primary aneurysmal bone cyst of the calcaneus in a pediatric patient through extensive curettage and allogeneic bone impaction grafting, which resulted in complete lesion ossification and no complications after a nine-year follow-up.
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Deep within the human skeleton, bones are not static pillars but living tissues that constantly repair and reshape themselves. Sometimes, however, this process goes awry, creating unusual growths. One such growth is the aneurysmal bone cyst, a benign but aggressive lesion filled with blood rather than solid tissue. Imagine a sponge that has been soaked in blood, expanding and thinning the bone around it until it becomes fragile. While these cysts can appear in many long bones, they are exceptionally rare in the foot, and even rarer in the heel bone, known medically as the calcaneus. When they do occur in this weight-bearing spot, they cause chronic pain and swelling, making simple walking a difficult task. Because the heel is a complex structure that supports the entire body's weight, treating a lesion there requires a delicate balance: removing the abnormal tissue completely while ensuring the bone remains strong enough to function for a lifetime.
This story follows the journey of a thirteen-year-old girl who arrived at a hospital with a two-year history of left heel pain. Over the last six months, her condition had worsened significantly; her heel had swollen, and the pain made walking difficult. Doctors examined her and found tenderness on the inner side of her heel. While she could still move her ankle normally, twisting her foot in or out triggered sharp pain. To understand what was happening inside, the medical team turned to imaging. X-rays showed a dark, expanding area on the outer back part of her heel bone. A more detailed scan revealed that the bone had been eroded and thinned by a cystic mass, which contained fluid and blood. Magnetic resonance imaging provided the clearest picture, showing a cyst with distinct layers of fluid and blood, surrounded by a thin shell of bone. Based on these images and her symptoms, the team suspected a calcaneal aneurysmal bone cyst, a diagnosis that would later be confirmed by examining the tissue under a microscope.
The treatment plan focused on removing the cyst entirely and rebuilding the bone. The surgeons used an approach from the side of the foot to expose the heel bone. They carefully opened a window in the bone to reach the cyst, which was filled with blood. Using a very fine wire, they drilled multiple small holes into the cavity to ensure every bit of the abnormal tissue was scraped away. This thorough cleaning, known as curettage, was essential to prevent the cyst from returning. Once the cavity was clear, the surgeons filled the empty space with compact pieces of donor bone, a material that would eventually fuse with the patient's own bone to restore its strength. After the surgery, the girl was kept off her feet for six weeks to allow the graft to settle, followed by a gradual return to walking, with full weight-bearing permitted after three months.
The results of this intervention were confirmed through a long-term follow-up. A microscopic examination of the removed tissue showed the classic features of a primary aneurysmal bone cyst: cavernous spaces filled with blood, separated by tissue containing specific cells like fibroblasts and giant cells. Most importantly, nine years after the surgery, the patient had made a full recovery. She was pain-free, active, and able to walk without difficulty. Imaging taken at this nine-year mark showed that the donor bone had completely fused with her heel, the lesion had turned into solid bone, and there was no sign of the cyst returning. This case demonstrates that even for a rare and challenging condition in a critical weight-bearing bone, a combination of careful surgical removal and bone grafting can lead to a permanent cure. While the heel is an uncommon location for this type of cyst, the successful outcome highlights the importance of accurate diagnosis and precise surgical technique in preserving the function of the foot.
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