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Tumors of the OS Calcis

1931; Radiological Society of North America; Volume: 16; Issue: 2 Linguagem: Inglês

10.1148/16.2.232

1527-1315

John R. Moore,

Sarcoma Diagnosis and Treatment

TUMORS of this bone are comparatively rare. Very recently Dr. Joseph C. Bloodgood and his staff at the Surgical Pathology Department, Johns Hopkins Hospital, studied some seventeen hundred bone tumors with special reference to anatomical location. Thirty-three, or approximately 2 per cent, involved the calcaneum. It is the intention at this time to briefly analyze these tumors with reference to age, incidence, symptomatology, pathology, and treatment, and to include a brief review of the tumors occurring in the literature. One might expect newgrowths in this area to be rather common if trauma were considered a very important etiologic factor. The os calcis forms a rather fixed pillar of the longitudinal arch; frequently it is forced to carry the entire weight of the body, as in jumping or falling and landing on the feet. It is constantly exposed to the irritation of ill-fitting shoes. Scudder remarks that it is the most frequently fractured bone in the foot. From the standpoint of anatomy and development and to some extent the behavior and types of the tumors frequently involving it, one's attention is called to its very close resemblance to the long pipe bones, i.e., the femur, tibia, etc. It is pre formed in cartilage, has an ossification center for the body and one for the apophysis and plantar calcaneo-tubercles. The latter two unite with the body about the fifteenth year, paralleling the osteogenesis noted in the long bones. It is covered by true periosteum. Two powerful tendons, the Achilles and the tibialis posticus (in part), insert in it; place of origin is also given to the plantar structures. Ewing's tumor, most commonly found in the long pipe bones, involved the calcaneum twice in this series and four times in cases reported in the literature. Chondromas occurring in the os calcis progress very much like the chondromas of the long bones and must be watched carefully for malignant changes. Geschickter (1) has emphasized the behavior of this type of tumor in the os calcis and has stressed its possible malignant tendencies in contrast to the cartilaginous tumors occurring in the metatarsals and phalanges, which are nearly always benign. Ninety-one tumors of the os calcis were found in the literature for the past fifty-one years. Of this group, 67 were benign exostoses, one chondroma, four bone cysts, four giant-cell tumors, two chondrosarcomas, four Ewing's endothelial myelomas, eight sarcomas (unclassified), and two epitheliomas. Briggs (2) reported an epithelial growth of the heel involving the os calcis in 1883; S. Bayer (3), a round-cell sarcoma of the os calcis in 1883; Jeannel (4), a chondroma of the calcaneum in 1885; Fahlenbock (5), a giant-cell sarcoma of the os calcis in 1894, while in 1914 W. P. Coues described what was probably the first bone cyst of the os calcis to be reported. Literature on exostoses probably antedates that on all other tumors of the os calcis.