Calcaneal Stress Fracture Presenting with Lateral Hindfoot Pain in a Young Woman: A Case Report

Calcaneal stress fracture is an uncommon osseous cause of heel and hindfoot pain. A 33-year-old woman with chronic underweight status (body mass index, 16.59 kg/m²) presented with a 2- to 3-week history of right lateral hindfoot pain that reportedly began during treadmill walking in association with a perceived twisting event. The medical record documented tenderness in the region of the calcaneofibular ligament and a negative talar tilt test, but heel-specific examination was incompletely documented. Magnetic resonance imaging (MRI) obtained at the initial evaluation was formally interpreted as showing a calcaneal tuberosity stress fracture and quadratus plantae strain, with no abnormality reported in the ankle ligament complexes. On retrospective MRI review, an incomplete, vertically oriented fracture line extending to the cortex without articular extension or osseous displacement was identified, with surrounding marrow signal abnormality meeting the imaging criteria for Nattiv grade 4. Weight-bearing radiographs obtained 4 days later showed a corresponding sclerotic band. This case illustrates MRI-radiographic correlation in a calcaneal tuberosity stress fracture presenting with lateral hindfoot pain and supports inclusion of osseous injury in the differential diagnosis.