Chronic Heel Pain? Intraosseous Lipoma of the Calcaneus on X-Ray and MRI
Chronic Heel Pain Is Not Always Plantar Fasciitis
Chronic heel pain is one of the most common complaints encountered in orthopedic, podiatric, sports medicine, and musculoskeletal radiology practice. Plantar fasciitis, Achilles tendinopathy, calcaneal stress fracture, and degenerative disorders are usually considered first. However, when heel pain persists despite appropriate conservative treatment, imaging should prompt clinicians to look beyond soft-tissue disorders and evaluate the bone itself.
One uncommon but important diagnosis is intraosseous lipoma, particularly calcaneal intraosseous lipoma.
An intraosseous lipoma is a rare benign bone lesion composed predominantly of mature adipose tissue within the medullary cavity. Although uncommon, the calcaneus is one of its characteristic locations. The lesion may be completely asymptomatic and discovered incidentally, or it may present with chronic, activity-related heel pain. Its importance lies not in malignant behavior—because it is generally benign—but in the fact that its radiographic appearance may resemble several other lytic bone lesions.
The attached case illustrates the classic diagnostic pathway particularly well: a well-defined lytic lesion in the calcaneus on radiography, followed by MRI demonstrating signal characteristics compatible with fat. casestudy_12
The most useful diagnostic principle is simple:
A well-defined calcaneal lytic lesion containing fat should raise strong consideration of intraosseous lipoma, especially when the lesion follows the signal of subcutaneous fat on MRI and suppresses on fat-suppressed sequences.
Case at a Glance: A 50-Year-Old Man With Chronic Ankle and Heel Pain
The case presented in the source document involves a 50-year-old man with chronic right ankle pain. Plain radiography revealed a localized lesion within the right calcaneus, and a non-contrast MRI examination was subsequently performed to characterize the lesion. casestudy_12
The lesion measured approximately 3 cm, was oval and well circumscribed, and showed a relatively thin sclerotic margin. A central mineralized or calcified focus was also visible. Importantly, the radiograph did not demonstrate obvious cortical destruction, aggressive periosteal reaction, or pathologic fracture. casestudy_12
On MRI, the lesion demonstrated high signal intensity on T1-weighted imaging similar to subcutaneous fat. On fat-suppressed imaging, the previously high signal decreased substantially, providing a critical clue that the lesion contained macroscopic fat. casestudy_12
This combination—well-defined lytic lesion + central calcification + T1 fat signal + fat suppression—is highly characteristic of a calcaneal intraosseous lipoma.
Figure 1. Right Ankle Lateral Radiograph
Radiologic interpretation:
The lateral radiograph demonstrates an approximately 3-cm, well-defined oval radiolucent lesion within the calcaneus. A thin sclerotic rim surrounds the lesion, and a central high-density focus is suspicious for calcification. There is no obvious cortical destruction, aggressive periosteal reaction, or pathologic fracture.
The attached case specifically describes these findings as a localized calcaneal osteolytic lesion with a thin sclerotic border and central calcification. casestudy_12
Educational message:
A well-defined sclerotic margin generally suggests a relatively indolent process, although benign appearance alone cannot establish a definitive diagnosis. The location, internal matrix, cortical integrity, and clinical history must be integrated.
Figure 2. Right Ankle Lateral Radiograph With Arrow
Radiologic interpretation:
The second radiographic image is the same lateral ankle projection with an arrow highlighting the intraosseous calcaneal lesion. The arrow emphasizes the well-circumscribed osteolytic lesion and central mineralized component. casestudy_12
Educational message:
This is a useful teaching image because recognizing the location of the lesion within the calcaneus is the first step toward narrowing the differential diagnosis.
Calcaneal intraosseous lipoma has a characteristic predilection for the region of the calcaneal neck/Ward's triangle, and previous literature has emphasized the importance of this characteristic location.
Figure 3. Sagittal T1-Weighted MRI
Radiologic interpretation:
The sagittal T1-weighted MRI demonstrates a sharply marginated lesion within the calcaneus. The lesion has relatively homogeneous high signal intensity comparable to adjacent subcutaneous fat.
This is one of the most important MRI findings in intraosseous lipoma diagnosis. Mature adipose tissue typically demonstrates high signal intensity on T1-weighted MRI. The source case emphasizes that the lesion's signal resembles normal subcutaneous fat. casestudy_12
Recommended alt text:
Sagittal T1 MRI showing a high-signal fat-containing lesion in the calcaneus.
Figure 4. Sagittal Fat-Suppressed MRI
Radiologic interpretation:
The fat-suppressed sagittal MRI demonstrates substantial reduction of the high signal previously seen on T1-weighted imaging. This signal suppression strongly supports the presence of macroscopic fat within the lesion. casestudy_12
Recommended alt text:
Sagittal fat-suppressed MRI demonstrating suppression of the calcaneal intraosseous lipoma.
This is arguably the most educational image in the case. A T1-hyperintense lesion is not automatically a lipoma because other substances, including blood products and certain proteinaceous materials, can also produce high T1 signal. Demonstrating fat suppression provides an important additional confirmation of the fat-containing nature of the lesion.
What Is an Intraosseous Lipoma?
An intraosseous lipoma is a rare benign lesion composed predominantly of mature adipocytes located within bone marrow.
It should be distinguished from an ordinary soft-tissue lipoma. A soft-tissue lipoma develops in subcutaneous tissue, muscle, or other soft-tissue compartments, whereas an intraosseous lipoma arises within the medullary cavity of bone.
Intraosseous lipoma is considered one of the rarest primary benign bone tumors. Older literature estimated that it accounts for approximately 0.1% of bone tumors, although its true prevalence may be underestimated because many lesions are asymptomatic or incidentally detected.
The 2025 systematic review focused specifically on calcaneal intraosseous lipoma and identified 36 patients from 27 eligible reports. The mean age was approximately 40 years, with a slight male predominance.
Pathophysiology of Intraosseous Lipoma
The exact pathogenesis of intraosseous lipoma remains incompletely understood.
Several mechanisms have historically been proposed.
1. Benign neoplastic proliferation
The classical interpretation considers intraosseous lipoma a benign primary neoplasm composed of mature adipocytes. Under this model, adipocytes within the bone marrow undergo localized proliferative expansion.
2. Post-traumatic or mechanical remodeling
Another hypothesis proposes that repetitive mechanical stress or trauma may contribute to the development of the lesion. This hypothesis is particularly interesting for the calcaneus because the bone experiences substantial repetitive loading during standing, walking, running, and jumping.
The attached case document also discusses trauma and repetitive mechanical stress as possible contributors, while emphasizing that the exact mechanism has not been established. casestudy_12
3. Evolution from fat necrosis or bone infarction
A third concept proposes that some lesions may represent an unusual evolutionary response to ischemic injury or fat necrosis rather than a conventional neoplasm.
This hypothesis is supported by the observation that intraosseous lipomas can contain necrotic fat, dystrophic calcification, cystic degeneration, and reactive bone formation.
Importantly, modern literature does not establish one definitive pathogenesis for every intraosseous lipoma. The safest interpretation is that the biological mechanism remains incompletely resolved.
Milgram Classification: Stage I, Stage II, and Stage III
One of the most important concepts in understanding intraosseous lipoma is the Milgram classification.
Milgram originally categorized intraosseous lipomas according to the degree of involution and degeneration.
Milgram Stage I
Stage I lesions predominantly contain viable mature adipocytes.
Imaging may show a well-defined radiolucent lesion containing fat, with relatively little mineralization or necrosis.
Milgram Stage II
Stage II represents an intermediate stage.
There is still viable fat, but the lesion develops:
- Fat necrosis
- Focal calcification
- Dystrophic mineralization
- Variable reactive bone formation
The classic appearance of a well-defined lytic lesion with central calcification is particularly relevant to this stage.
Milgram Stage III
Stage III represents more advanced involution.
The lesion may demonstrate:
- Extensive fat necrosis
- Cystic degeneration
- Extensive calcification
- Reactive new bone formation
- More prominent sclerosis
As a result, a Stage III intraosseous lipoma can become considerably more difficult to distinguish from bone infarction or other lytic/sclerotic lesions.
The 2000 radiologic-pathologic correlation study emphasized that radiographic, CT, and MRI appearances vary according to the degree of involution and necrosis.
Epidemiology
Intraosseous lipoma is uncommon, and precise population-based incidence data are limited.
The lesion is typically identified in adults. Earlier large series reported a mean age in the fourth decade, while calcaneal series commonly show patients in the third through sixth decades.
The calcaneus is one of the most characteristic sites.
Other reported locations include:
- Proximal femur
- Tibia
- Fibula
- Pelvis
- Other long bones
- Flat bones
The calcaneal predilection may relate to the abundant fatty marrow in this region and potentially to local mechanical factors. However, a definitive etiologic explanation remains unavailable.
The 2025 systematic review found a mean age of 40.3 years among 36 reported calcaneal cases, with 58.3% male patients. Approximately 55.6% had heel pain, while 19.4% were incidental findings.
Clinical Presentation
The clinical presentation of intraosseous lipoma is variable.
Asymptomatic lesions
Many intraosseous lipomas are discovered incidentally.
A patient may undergo ankle radiography, CT, or MRI for trauma, degenerative disease, plantar heel pain, or another unrelated condition, and the intraosseous lipoma is found unexpectedly.
This is clinically important because finding an intraosseous lipoma does not automatically prove that the lesion is responsible for the patient's pain.
The attached case document specifically cautions that the lesion may be incidental and that clinicians should establish whether the location of pain corresponds to the location and mechanical relevance of the lesion. casestudy_12
Symptomatic lesions
When symptoms occur, patients may experience:
- Chronic heel pain
- Activity-related pain
- Pain after prolonged standing
- Pain during walking
- Pain after exercise
- Local tenderness
- Occasionally swelling
A 2024 case report described calcaneal intraosseous lipoma as an uncommon cause of chronic heel pain and reported symptom resolution after surgical treatment.
A particularly important clinical pitfall is mistaking the pain for plantar fasciitis. A recent report emphasized that nonspecific plantar heel pain from a calcaneal intraosseous lipoma may be clinically confused with plantar fasciitis.
Imaging Features of Intraosseous Lipoma
X-Ray
Plain radiography remains an important first-line examination.
Typical findings include:
- Well-defined osteolytic lesion
- Oval or round configuration
- Thin sclerotic margin
- Central calcification
- Preserved cortical outline
- Lack of aggressive periosteal reaction
The source case demonstrates this classic pattern essentially. casestudy_12
The central calcification is particularly valuable because it may reflect dystrophic calcification associated with fat necrosis.
However, X-ray cannot always prove that the lesion contains fat.
MRI
MRI is particularly useful because it can characterize tissue composition.
T1-weighted MRI
Mature fat generally appears bright on T1-weighted sequences.
A lesion that has T1 signal intensity similar to subcutaneous fat should therefore raise suspicion for an intraosseous lipoma.
Fat-suppressed MRI
The next critical question is:
Does the high T1 signal suppress on a fat-suppressed sequence?
If the answer is yes, the imaging evidence for macroscopic fat becomes much stronger.
The classic MRI pattern is therefore:
T1 high signal → fat suppression → marked signal loss
The attached case demonstrates exactly this sequence of findings. casestudy_12
T2 and STIR
T2-weighted and STIR sequences help evaluate:
- Fluid
- Bone marrow edema
- Inflammatory change
- Necrotic components
- Cystic degeneration
More advanced intraosseous lipomas may have heterogeneous MRI characteristics because fat necrosis and cystic degeneration alter the signal pattern. PubMed
CT in Calcaneal Intraosseous Lipoma
CT is not mandatory for every patient.
However, CT can be extremely useful when radiographs or MRI leave uncertainty.
CT can better demonstrate:
- Cortical integrity
- Internal calcification
- Trabecular architecture
- Lesion expansion
- Fat attenuation
- Structural weakening
A lesion demonstrating fat attenuation on CT provides additional evidence supporting intraosseous lipoma.
The major advantage of CT is its ability to demonstrate the bone architecture and mineralized components in greater detail than MRI.
The attached case appropriately emphasizes that CT is especially useful when calcification is uncertain, cortical thinning is suspected, fracture risk needs assessment, or MRI findings are atypical. casestudy_12
Differential Diagnosis
A calcaneal lytic lesion should never be diagnosed solely because it looks "cystic."
The differential diagnosis includes several entities.
| Differential diagnosis | Typical clue | Key distinction from intraosseous lipoma |
|---|---|---|
| Intraosseous lipoma | T1 fat signal, fat suppression, central calcification | Macroscopic fat |
| Simple/unicameral bone cyst | T1 low, T2 high fluid | Predominantly fluid |
| Aneurysmal bone cyst | Expansile lesion, septations, fluid-fluid levels | Blood/fluid compartments |
| Bone infarction | Serpiginous sclerosis | Characteristic peripheral pattern |
| Fibrous dysplasia | Ground-glass matrix | Fibrous osseous matrix |
| Chondroid lesion | Chondroid calcification | Cartilage matrix |
| Other benign/malignant bone lesions | Variable | Aggressive features may be present |
The attached document specifically lists simple bone cyst, aneurysmal bone cyst, bone infarction, fibrous dysplasia, and chondroid tumors among important differential diagnoses. casestudy_12
Intraosseous Lipoma vs Simple Bone Cyst
This is one of the most practical distinctions in a calcaneal lesion.
A simple bone cyst is primarily a fluid-containing lesion.
MRI generally shows:
- Low T1 signal
- High T2 signal
In contrast, intraosseous lipoma demonstrates fat signal:
- High T1 signal
- Signal similar to subcutaneous fat
- Suppression on fat-suppressed imaging
Therefore, MRI often provides the decisive distinction.
Intraosseous Lipoma vs Bone Infarction
This differential can become difficult, especially with advanced or involuted lesions.
Both may contain:
- Fat-related signal
- Sclerosis
- Calcification
- Necrotic components
Milgram Stage III intraosseous lipoma may resemble bone infarction.
However, radiologic-pathologic studies have emphasized that bone infarcts typically demonstrate a characteristic serpiginous peripheral pattern and generally lack the same type of expansile trabecular resorption seen in some intraosseous lipomas.
When imaging is ambiguous, CT, MRI, clinical history, serial imaging, and occasionally biopsy must be considered together.
When Should an Aggressive Lesion Be Suspected?
Although intraosseous lipoma is benign, clinicians should not label every calcaneal lytic lesion as a lipoma.
Warning signs include:
- Cortical destruction
- Aggressive cortical breakthrough
- Soft-tissue mass
- Aggressive periosteal reaction
- Rapid interval enlargement
- Extensive unexplained marrow edema
- Severe unexplained progressive pain
- Pathologic fracture
- Imaging findings inconsistent with macroscopic fat
The source document specifically recommends further assessment when cortical destruction, aggressive expansion, periosteal reaction, or a soft-tissue mass is present. casestudy_12
Diagnosis
The diagnosis of intraosseous lipoma is fundamentally an integrated radiologic-clinical diagnosis.
A practical diagnostic pathway is:
Step 1: Identify the lesion on radiography
Determine:
- Location
- Size
- Margins
- Sclerosis
- Calcification
- Cortical integrity
Step 2: Characterize the tissue on MRI
Ask:
- Is the lesion T1 hyperintense?
- Is the signal comparable with subcutaneous fat?
- Does it suppress on fat-suppressed imaging?
- Is there marrow edema?
- Is there cortical destruction?
- Is there a soft-tissue component?
Step 3: Use CT selectively
CT is particularly useful when calcification, cortical structure, or fat attenuation needs clarification.
Step 4: Decide whether biopsy is necessary
If imaging is classic and non-aggressive, biopsy may not be necessary.
If imaging is atypical, progressive, aggressive, or discordant with the clinical picture, orthopedic oncology or musculoskeletal radiology consultation should be considered.
The 2025 systematic review concluded that recognition of characteristic imaging findings may help prevent unnecessary invasive procedures.
Treatment of Intraosseous Lipoma
Treatment should be individualized.
Observation and Conservative Management
For an asymptomatic or minimally symptomatic lesion with classic benign imaging features, observation is reasonable.
Conservative management can include:
- Activity modification
- Analgesic therapy when appropriate
- Reduction of repetitive heel loading
- Clinical follow-up
- Imaging follow-up when clinically indicated
The attached case specifically recommends conservative management when the lesion is radiologically typical, stable, and structurally low-risk. casestudy_12
The 2025 systematic review also supports observation for incidental lesions. Among the 36 calcaneal cases, 27.8% were managed conservatively, with favorable reported outcomes.
When Is Surgery Considered?
Surgery may be considered when:
- Pain persists despite conservative treatment
- The lesion is structurally large
- There is significant cortical thinning
- Pathologic fracture risk is considered substantial
- The diagnosis remains uncertain
- Imaging is atypical
- The patient has clinically significant symptoms attributable to the lesion
A common surgical approach is curettage, sometimes followed by bone grafting or another method of defect filling.
The decision should not be based solely on lesion size. Location, cortical integrity, mechanical loading, symptoms, and diagnostic certainty all matter.
The 2025 systematic review found that curettage was performed in 72.2% of the reported calcaneal cases, although the authors emphasized that management is not standardized.
A 2024 case report similarly described curettage and bone cement filling for symptomatic calcaneal intraosseous lipoma, with no residual pain at 2.5-year follow-up.
Prognosis
The prognosis of typical intraosseous lipoma is generally excellent.
It is a benign lesion, and the most recent calcaneal systematic review found:
- No malignant transformation in the included cases
- No reported recurrence
- Favorable outcomes with both observation and surgery
- Stable or improving lesions in conservatively managed patients
Follow-up across the reviewed cases ranged from approximately six months to seven years.
Nevertheless, "benign" does not mean that every patient requires no follow-up.
A lesion that causes structural weakening of the calcaneus may potentially become clinically important, particularly if a pathologic fracture occurs.
Similarly, worsening symptoms should prompt reassessment because the pain may arise from another condition—or because the original imaging interpretation may have been incomplete.
What This Case Teaches Us About Heel Pain
This case provides an important diagnostic lesson:
Do not automatically attribute chronic heel pain to plantar fasciitis.
If symptoms persist or the clinical course is atypical, imaging may reveal an unexpected osseous cause.
The most useful radiologic clues in this case are:
- A well-defined calcaneal lytic lesion.
- A thin sclerotic margin.
- Central calcification.
- T1 hyperintensity comparable with fat.
- Suppression of signal on fat-suppressed MRI.
- Preservation of the cortex.
- Absence of an aggressive soft-tissue component.
Together, these findings strongly favor calcaneal intraosseous lipoma. casestudy_12
Frequently Asked Questions: Intraosseous Lipoma
Is intraosseous lipoma cancer?
Usually, no. Intraosseous lipoma is a benign bone lesion. Current calcaneal case literature has not demonstrated malignant transformation in the reported cases included in the 2025 systematic review.
Can intraosseous lipoma cause heel pain?
Yes. Some patients develop chronic heel pain, particularly with weight-bearing activity. However, an incidental intraosseous lipoma may have nothing to do with the patient's symptoms.
What does intraosseous lipoma look like on X-ray?
A typical lesion is well-defined and radiolucent, often with a thin sclerotic margin and sometimes central calcification.
What does intraosseous lipoma look like on MRI?
The fatty component generally demonstrates high T1 signal similar to subcutaneous fat and decreases in signal on fat-suppressed sequences.
Is MRI better than X-ray for diagnosing intraosseous lipoma?
They answer different questions. X-ray is excellent for detecting the lesion, its location, margins, sclerosis, and mineralization. MRI is particularly useful for confirming fat composition and evaluating marrow and soft tissues. CT can complement both by characterizing cortical bone and calcification.
Does every intraosseous lipoma need surgery?
No. Observation is reasonable for many asymptomatic or minimally symptomatic lesions with classic benign imaging findings. Surgery is generally considered when symptoms persist, structural risk is significant, or the diagnosis remains uncertain.
Three Medical Learning Questions
Question 1 — X-Ray Diagnosis
A 50-year-old man has chronic heel pain. X-ray shows a 3-cm, well-defined osteolytic lesion in the calcaneus with a thin sclerotic margin and central calcification. There is no obvious cortical destruction.
What is the most appropriate next diagnostic approach?
A. Immediately diagnose osteosarcoma
B. Consider intraosseous lipoma and evaluate the lesion for macroscopic fat with MRI
C. Perform immediate wide excision
D. Diagnose a simple bone cyst solely from the X-ray
E. Assume all calcaneal lytic lesions are malignant
Correct answer: B
Explanation
The combination of a well-defined lytic lesion, thin sclerotic margin, and central calcification is compatible with intraosseous lipoma. MRI can determine whether the lesion contains macroscopic fat by evaluating T1 signal and fat suppression. The source case uses precisely this diagnostic logic. casestudy_12
Question 2 — MRI Diagnosis
A calcaneal lesion is hyperintense on T1-weighted MRI, with signal similar to subcutaneous fat. On fat-suppressed imaging, the lesion becomes markedly hypointense.
What does this combination most strongly indicate?
A. Pure fluid
B. Macroscopic fat within the lesion
C. Malignant bone tumor
D. Fibrous dysplasia
E. Acute osteomyelitis
Correct answer: B
Explanation
T1 hyperintensity by itself is not specific. However, signal similar to subcutaneous fat combined with substantial suppression on fat-suppressed MRI strongly supports the presence of macroscopic fat. In the appropriate radiographic context, this strongly supports intraosseous lipoma. casestudy_12
Question 3 — Treatment
A patient has a typical calcaneal intraosseous lipoma. MRI demonstrates fat signal and fat suppression. The lesion is well circumscribed; there is no soft-tissue mass, the cortex is preserved, and the patient has only mild pain without evidence of fracture risk.
What is the most appropriate management?
A. Mandatory immediate surgery
B. Chemotherapy
C. Individualized conservative management and clinical observation
D. Treat the lesion as malignant
E. Stop all future clinical assessment permanently
Correct answer: C
Explanation
A classic benign imaging appearance with low structural risk does not automatically require surgery. Conservative treatment and individualized follow-up are reasonable. Surgery becomes more relevant when symptoms persist, structural stability is threatened, or the diagnosis is uncertain. casestudy_12
Bottom Line for Radiologists, Orthopedic Surgeons, and Patients
Calcaneal intraosseous lipoma is rare, benign, and frequently indolent—but it is an important imaging diagnosis because it can mimic other lytic bone lesions.
The most useful diagnostic pattern is:
Well-defined calcaneal lytic lesion + sclerotic rim ± central calcification + T1 fat signal + fat suppression = strongly consider intraosseous lipoma.
MRI is especially valuable for demonstrating the fatty nature of the lesion, while CT is complementary when mineralization or cortical architecture requires clarification.
For an asymptomatic or minimally symptomatic patient with classic benign imaging, observation may be appropriate. Persistent pain, structural weakening, suspected pathologic fracture, atypical imaging, or diagnostic uncertainty should prompt specialist assessment.
The modern literature also supports an important principle: recognizing the characteristic imaging phenotype can prevent unnecessary biopsy and surgery, while maintaining an appropriately cautious approach to atypical or aggressive-appearing lesions.
References
[1] A. W. Youssef, P. M. Doney, C. Ballard, D. Dalbey, and J. Harrington, “Intraosseous Lipoma of the Calcaneus: A Systematic Review of Reported Cases, Imaging Characteristics, and Treatment Outcomes,” Cureus, vol. 17, no. 12, p. e99932, 2025, doi: 10.7759/cureus.99932. Cureus
[2] J. W. Milgram, “Intraosseous lipomas: Radiologic and pathologic manifestations,” Radiology, vol. 167, no. 1, pp. 155–160, 1988, doi: 10.1148/radiology.167.1.3347718. PubMed
[3] T. Propeck, M. A. Bullard, J. Lin, K. Doi, and W. Martel, “Radiologic-pathologic correlation of intraosseous lipomas,” American Journal of Roentgenology, vol. 175, no. 3, pp. 673–678, 2000, doi: 10.2214/ajr.175.3.1750673. DOI
[4] R. S. D. Campbell, A. J. Grainger, D. C. Mangham, I. Beggs, J. Teh, and A. M. Davies, “Intraosseous lipoma: Report of 35 new cases and a review of the literature,” Skeletal Radiology, vol. 32, no. 4, pp. 209–222, 2003, doi: 10.1007/s00256-002-0616-7. PubMed
[5] M. F. Blacksin, N. Ende, and J. Benevenia, “Magnetic resonance imaging of intraosseous lipomas: A radiologic-pathologic correlation,” Skeletal Radiology, vol. 24, no. 1, pp. 37–41, 1995, doi: 10.1007/BF02425945. PubMed
[6] H. S. Kang, T. Kim, S. Oh, S. Park, and S. H. Chung, “Intraosseous Lipoma: 18 Years of Experience at a Single Institution,” Clinics in Orthopedic Surgery, vol. 10, no. 2, pp. 234–239, 2018, doi: 10.4055/cios.2018.10.2.234. PubMed
[7] C. Bertram, F. Popken, and J. Rütt, “Intraosseous lipoma of the calcaneus,” Langenbeck's Archives of Surgery, vol. 386, pp. 313–317, 2001, doi: 10.1007/s004230100202. PubMed
[8] S. Narang and M. Gangopadhyay, “Calcaneal intraosseous lipoma: A case report and review of the literature,” The Journal of Foot & Ankle Surgery, vol. 50, no. 2, pp. 216–220, 2011, doi: 10.1053/j.jfas.2010.12.004. PubMed
[9] M. D. Murphey, J. F. Carroll, D. J. Flemming, T. L. Pope, F. H. Gannon, and M. J. Kransdorf, “From the archives of the AFIP: Benign musculoskeletal lipomatous lesions,” RadioGraphics, vol. 24, no. 5, pp. 1433–1466, 2004, doi: 10.1148/rg.245045120. PubMed
[10] D. K. Yadav, A. K. Yadav, S. R. Paudel, and D. Yadav, “Intraosseous Lipoma of Calcaneus An Uncommon Cause of Heel Pain: A Case Report,” Journal of Nepal Medical Association, vol. 62, no. 273, pp. 332–335, 2024, doi: 10.31729/jnma.8581. PubMed
[11] J. K. B. Sobota, H. Kienapfel, M. Werner, and D. M. Vogt, “Intraosseous myolipoma of the calcaneus,” BMJ Case Reports, vol. 17, no. 3, p. e259743, 2024, doi: 10.1136/bcr-2024-259743. This is a related but distinct fat-containing calcaneal lesion and is useful when discussing the limits of radiologic diagnosis.
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