A 40-year-old male patient presented to our emergency department with right heel pain. The patient's pain has been present for 3 months and has worsened for the last month. Due to the pain, he could not weightbear on his right foot. In the anamnesis of the patient, it was learned that he was diagnosed with lung cancer 2 years ago. In the examination of the patient, there was edema, mild temperature increase and severe sensitivity in the right heel. X-ray images showed a lobule contoured sclerotic mass in the posterior calcaneus. In contrast-enhanced Magnetic Resonance images, minimal bony medullary surrounding approximately 30x28x24mm in size, bilobed, with irregular borders, hypointense areas in the central, generally hyperintense lobulated contoured mass lesion in the posterior part of the calcaneus is observed(Figure 1a). Metastatic carcinoma was considered as a preliminary diagnosis in the patient with a history of lung cancer. Needle biopsy was performed and the pathology report was reported as metastatic adenocarcinoma(Figure 1b).Surgery was performed for the patient after the pathological diagnosis was made. The calcaneus was reached with the L shape lateral approach. The defect after mass excision was reconstructed with methylmethacrylate(Figure 2). The patient was allowed to mobilize by weightbearing as much as he could tolerate the next day after surgery. At the second week after surgery, 2000 cGy dose of radiotherapy was applied in 5 fractions directed to the calcaneus. No complications were encountered after surgery, and the patient had no symptoms and recurrence at the end of the first year follow-up.

Bone metastasis to the calcaneus is a quite rare condition. It should be kept in mind in the differential diagnosis of patients with cancer history in their anamnesis. Curettage of the metastatic mass and defect reconstruction with methylmethacrylate are an effective method in the metastases of calcaneus.

• 4 times more confident to identify optimal time for initial CT
• >5 times more confident in identifying indications for scanning

The above was also reflected in the re-audit which showed

• Less scans were justified via diagnostic uncertainty
• Increased Percentage of CT’s that adhere to the optimal timing – 66% vs 40%