Atraumatic Bilateral Calcaneal Insufficiency Fractures in a Postmenopausal Woman With Severe Osteoporosis: A Case Report

Calcaneal insufficiency fractures are uncommon and often overlooked because their early symptoms resemble more prevalent causes of heel pain. A 68-year-old postmenopausal woman presented with two months of progressive bilateral heel pain and swelling without trauma. Radiographs revealed nondisplaced bilateral calcaneal fractures characterized by subtle vertical lucencies and mild cortical discontinuity. Dual-energy X-ray absorptiometry confirmed severe osteoporosis, and laboratory evaluation excluded secondary metabolic bone disease. The initial symptoms mimicked plantar fasciitis and Achilles tendinopathy, contributing to diagnostic delay. Conservative management, including protected weight bearing, romosozumab, calcium, and vitamin D supplementation, resulted in steady improvement, with pain-free ambulation achieved within three months. Follow-up radiographs demonstrated complete resolution of the fracture line and restoration of normal trabecular architecture. Persistent atraumatic heel pain in elderly patients should prompt evaluation for calcaneal insufficiency fractures, and early imaging combined with bone mineral density assessment is essential for timely diagnosis and optimal management.