Presentation
Sudden foot pain after skiing, not able to bear weight. On radiograph elsewhere no fracture. Pain went away, two months later pain during long walks. Sports: running and strength training 2-3 times a week. No relevant prior history. At physical examination pain lateral aspect of tarsal sinus.
Patient Data
Sharp demarcated hypo-intense lesion in the anterior calcaneus in keeping with an intra-osseous lipoma. No fractures noted on AP (not shown) or lateral views.
Diffuse high signal intensity in the m. abductor minimi in keeping with denervation. No striking atrophy.
No signs of a fracture.
Incidental finding: intra-osseous lipoma in the anterior calcaneus
Case Discussion
The imaging findings support the diagnosis of Baxter neuropathy, in which the inferior calcaneal nerve is compressed resulting in denervation of either the m. abductor minimi or the m. quadratus plantae.
A probable explanation of the patient's story would be that a skiing trauma resulted in a fracture at the site of the intra-osseous lipoma, occult on the available images. The fracture healing may have compromised the inferior calcaneal nerve, e.g. by means of fibrosis, cortical irregularities or periosteal reaction, causing the now observed denervation.
However, as the patient did not exhibit typical clinical symptoms that could fit with Baxter neuropathy no treatment was indicated.
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