Prominent Vascular Remnants in the Calcaneus

A subtalar focus of signal abnormality within the calcaneus near the insertion of the cervical and interosseous ligaments represents a benign finding consistent with prominent vascular remnants and should not be confused with pathology. Histologically, this represents thinned cortical bone surrounded by fatty marrow and numerous dilated vascular channels.

On MRI, there is a focus of increased T2 and decreased T1 signal within the calcaneus in a characteristic subtalar location.

The main differential consideration is a subtalar subchondral cyst, which would have a similar appearance but would have to be subarticular.

References

Fleming JL 2nd, Dodd L, Helms CA. Prominent vascular remnants in the calcaneus simulating a lesion on MRI of the ankle: findings in 67 patients with cadaveric correlation. AJR Am J Roentgenol. 2005 Dec;185(6):1449-52.