Hepatocellular carcinoma (HCC) metastasizes mainly in the liver through portal vein, only few patients report metastases in distant organs and bone is considered a rare site of HCC metastases. We report the case of a man with HCC, who presented with chronic right hindfoot pain, in which bone scintigraphy and computed tomography (CT) revealed a rare secondary calcaneus localization.

Case description. A 58-year-old man with multi-treated HCC, during a hepatological follow-up, complained of chronic right hindfoot pain, unresponsive to analgesic therapy. The bone scintigraphy shows focal hypercaptations in the right calcaneus and, less evidently, in the right tibia. CT showed multiple focal solid enhancing nodules in the tibial bone marrow, and a 3,5-cm solid enhancing nodule in the calcaneal body, with cortical interruption and invasion of adjacent soft tissues. HCC calcaneal metastasis was confirmed through a biopsy.

Conclusion. In a patient with HCC and chronic hindfoot pain, with increase of alpha-fetoprotein levels, the possibility of a distant metastasis should be taken in account, as in our case, even though it is a rare cause.