A Diagnostic Approach to Symptomatic Distal Tibial Enchondroma in a Child

Abstract Objective: We present a diagnostic approach to an enchondroma at a very rare anatomical location, characterized by atypical clinical and imaging features. Сase report: A 10-year-6-month-old girl presented with a six-month history of pain and swelling of the left ankle, refractory to nonsteroidal anti-inflammatory drug (NSAID) therapy. Comprehensive clinical evaluation, conventional radiography, computed tomography (CT) and magnetic resonance imaging (MRI), as well as laboratory and microbiological investigations, were performed. These assessments excluded specific and nonspecific inflammatory conditions, traumatic injuries, bone infarction, overuse-related tenosynovitis, and other common etiologies; however, they proved insufficient for definitive diagnosis. Consequently, open intralesional curettage with biopsy was undertaken. Histopathological examination established the final diagnosis. Conclusions: Enchondromas typically exhibit distinct clinical and radiographic features that facilitate straightforward identification. However, occurrence at atypical locations or presentation with pain may result in significant diagnostic uncertainty. We recommend biopsy with intralesional curettage as the most informative diagnostic approach for atypical bone lesions in the pediatric population.