A clinical case of ossification in soft tissues of the plantar surface in projection of the calcaneus

BACKGROUND: Soft tissue ossificates is not a frequent complication in adults, and are even less common in pediatric practice. The described clinical case is an example of revealing a plantar surface ossificate in an 8-year-old patient with an unburdened somatic history, without previous severe injury. The acute onset of the disease, local pain syndrome with local tissues reaction and impaired walking function demanded exclusion of acute inflammatory disease, bone traumatic injury. Clinical and instrumental examination as well as surgical intervention revealed ossificates in the plantar surface in the calcaneus projection confirmed by morphological testing. Foci of pathological ossification which develop outside the skeleton bones (ossificates) can complicate the course of severe trauma, including central nervous system impairments, or they may be symptoms of genetic or systemic disease of the skeleton. In the literature, there are described cases of ossificates in adults, less often in children.

CLINICAL CASE DESCRIPTION: The patient was 8 years old. She was hospitalized in an urgent order with the preliminary diagnosis “M86.9 osteomyelitis of the left calcaneus(?)”. The patient complained of pain on the plantar surface of the left heel, lameness — inability to step on the left heel, local edema, hyperemia and marked tenderness during palpation of soft tissues. Disease history: 3 days before hospitalization, being home, she jumped to the floor from the height of 40–50 cm, and immediately felt pain, inability to walk, swelling on the plantar surface of the left heel.

CONCLUSION: The presented clinical case required additional instrumental and differential diagnostics to exclude acute inflammatory reaction in the calcaneus and in the surrounding tissues. Diagnostic and curative procedures revealed an ossificate in soft tissues of the plantar surface in projection of the calcaneus.