Pathologies of the processus anterior calcanei (PAC) are not infrequent and are a cause of persisting or chronic pain in the foot. Multiple etiologies can affect it: acute fractures, pseudo-arthrosis or normal variants of anatomy, such as an Os calcaneus accessorius (OCS). A close examination and accurate knowledge allow proper differentiation between all of them.
Patient A was a man who came because of persistent pain in his foot. A CT reported a crescent-shaped notch at the anterior calcaneal facet with a pea-shape that corresponded to an OCS. Pseudarthrosis of the PAC was first considered as an option, but it was rejected because it was a bilateral finding that preserved the cortical surface in all its shapes.
Patient B was a man who came after an accident. Multiple fractures were observed, which affected the anterior calcaneal facet. Because of the recent accident and because there was no cortical surface surrounding the fractures, their acute etiology was obvious.
Patient C was a man who was operated on a non-consolidated ankle fracture. CT showed a lineal band in the PAC suggestive of pseudo-arthrosis. The multiple fractures and the subacute etiology of the findings made it obvious that it was pseudo-arthrosis and not an OCS.
Patient D was a woman who suffered an astragal neck fracture that was treated conservatively. No fractures affected the PAC, which demonstrated its normal shape.
