DOI: https://doi.org/10.36347/sasjs.2026.v12i06.006

Pages: 561-566

Benign fibrous histiocytoma (BFH) of bone, presenting histologically as a non-ossifying fibroma (NOF), is a well-documented entity in long bone metaphysis but remains exceptionally rare in the calcaneus. We report the case of a 19-year-old male with a several-month history of progressive left heel pain causing significant functional impairment, including school absenteeism, with no antecedent trauma. Plain radiographs revealed a large, well-defined radiolucent lesion in the calcaneal body with a thin sclerotic rim and cortical thinning; computed tomography confirmed an expansile lytic lesion without aggressive features, initially interpreted as a unicameral bone cyst. After comprehensive preoperative evaluation, the patient underwent surgery via a sinus tarsi approach: extensive curettage was performed, and the osseous defect was reconstructed with autogenous iliac crest bone graft supplemented with Cerament®. Histopathological analysis of the curetted specimens confirmed a benign fibrohistiocytic tumour with spindle cell proliferation in a storiform pattern, establishing the definitive diagnosis of NOF. The postoperative course was uneventful; pain resolved completely within five weeks, and full weight-bearing was authorized at two months. Radiological follow-up at six months confirmed near-complete osseous consolidation without evidence of local recurrence. This case highlights the diagnostic challenges inherent to lytic calcaneal lesions, where imaging overlap with unicameral and aneurysmal bone cysts may obscure the true diagnosis, and underscores the indispensable role of histopathological confirmation. The favourable clinical and radiological outcomes demonstrate that thorough curettage combined with autogenous and synthetic bone grafting represents an effective surgical strategy for symptomatic BFH in critical weight-bearing sites. Clinicians should consider BFH/NOF in the differential diagnosis of calcaneal lytic lesions in adolescents and young adults.