Calcaneus fracture

Background

Bones of the foot.
  • Associated injuries are common

Types

  • Intra-articular (75%)
    • Sclerotic line may be only evidence of impacted fracture
  • Extra-articular (25%)
    • Anterior process fracture is most common

Clinical Features

  • Foot pain after trauma - often from axial load such as fall from height or motor vehicle accident

Differential Diagnosis

Foot and Toe Fractures

Hindfoot

Midfoot

Forefoot

Evaluation

(A) Normal Boehler's angle and (B) Abnormal Boehler's angle
  • Plain X-ray imaging
    • Decreased Boehler's angle (<25') may be only sign of fracture (compare with opposite side)
    • Harris view to tuberosity
  • Up to half of patients with calcaneus fractures have concomitant injuries including compression fractures of thoracolumbar spine [1]

Management & Disposition

General Fracture Management

Intra-articular fracture

  • Immobilization with posterior ankle splint
  • Non-weight bearing
  • Elevation (very important - fracture has high rate of severe swelling)
  • Ortho consult

Extra-articular fracture

See Also

Video

References

  1. Sanders RW, Clare MP. Calcaneous fractures. In: Rockwood and Green's Fractures in Adults, 7th, Bucholz, RW, Heckman JD, Court-Brown CM, Tornetta P (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.2064.