A case of bilateral but not unilateral insufficient calcaneus fractures in a patient with rheumatoid arthritis suffering from talalgia

Osteoporosis is a major complication of rheumatoid arthritis (RA), caused by glucocorticoid use and chronic inflammation, leading to an increased fracture risk. We report a rare case of bilateral insufficiency calcaneal fractures presenting with talalgia and swelling in a patient with RA who was initially misdiagnosed as having a disease relapse and treated with escalated biological disease-modifying antirheumatic drugs. Subsequent foot magnetic resonance imaging (MRI) revealed bone marrow edema and bilateral fracture lines in the posterior calcaneus without synovitis. This case highlights that talalgia in patients with RA may reflect insufficiency fractures rather than disease relapse, and appropriate imaging evaluation is therefore important for an early and accurate diagnosis.