Symptomatic Calcaneal Intraosseous Lipoma Mimicking Refractory Heel Pain: A Case Report and Review of the Literature.

Intraosseous lipomas (IOLs) are rare benign primary bone tumors, most commonly affecting the calcaneus. Although often asymptomatic, IOLs may present with persistent heel pain mimicking plantar fasciitis. Accurate diagnosis depends on characteristic radiological features, whereas the management strategy remains debated between conservative and surgical approaches. A 52-year-old construction worker with 4 months of activity-related left heel pain presented with calcaneal tenderness and no systemic inflammatory signs. Radiographs and computed tomography demonstrated a well-defined calcaneal lesion with central calcification, consistent with IOLs. Surgical treatment included curettage, evacuation of lipid contents, and autologous iliac-crest bone grafting. Postoperative recovery was uncomplicated with stable neurovascular status and adequate pain control. The patient resumed unrestricted ambulation at 2 months postoperatively. At 6 months follow-up, he reported complete resolution of pain and had resumed normal weight-bearing activities without limp or functional limitation. IOLs should be included in the differential diagnosis of refractory heel pain. Surgical curettage combined with autologous bone grafting produces excellent functional outcomes and immediate structural support, preventing pathological fractures in active patients.