463:(because of less soft tissue manipulation) and decreased intraoperative time. However, this procedure has increased risk of inadequate calcaneal bone fixation, compared to open procedures. Currently, open reduction with internal fixation (ORIF) is usually the preferred surgical approach when dealing with displaced intra-articular fractures. Newer, more innovative surgical techniques and equipment have decreased the incidence of intra- and post-operative complications. An updated (2023) systematic review found with limited confidence that surgery may lead to improved functional outcomes but at the risk of unplanned second surgeries. With the growing prevalence of minimally invasive surgeries further studies are needed to better determine if these newer surgical interventions offer improved outcomes.
508:
performed, the foot should be submitted to frequent range of motion exercises. The second phase occurs 6 weeks after and consists of keeping the foot elevated and iced while resting and performing exercises in which only slight weight is applied to the affected area for the next two weeks, others recommend six weeks of this phase. In this phase, range of motion exercises should be implemented if surgery was needed for the fracture. The third and final phase of rehabilitation of calcaneal fractures is to allow the full body weight to be used and use crutches or a cane if needed, between 13 weeks to a year the patient is allowed to resume normal activities.
472:
258:
or bone. Ligament and tendon involvement should also be explored. Achilles tendon injury can be seen with posterior (Type C) fractures. Since calcaneal fractures are related to falls from height, other concomitant injuries should be evaluated. Vertebral compression fractures occur in approximately 10% of these patients. A trauma-focused clinical approach should be implemented; tibial, knee, femur, hip, and head injuries should be ruled out by means of history and physical exam.
360:
249:
Upon inspection, the examiner may notice swelling, redness, and hematomas. A hematoma extending to the sole of the foot is called "Mondor Sign", and is pathognomonic for calcaneal fracture. The heel may also become widened with associated edema due to displacement of lateral calcaneal border. Soft tissue involvement should be evaluated because of the association with serious complications (see below).
336:
389:
anatomic landmark seen in lateral radiographs. It is formed by the intersection of 1) a line from the highest point of the posterior articular facet to the highest point of the posterior tuberosity, and 2) a line from the former to the highest point on the anterior articular facet. Böhler's angle is normally 25° to 40°. It is named after
Austrian physician
480:
368:
48:
388:
The Angle of
Gissane, or "Critical Angle", is the angle formed by the downward and upward slopes of the calcaneal superior surface. On a lateral radiograph, an angle of Gissane > 130° suggests fracture of the posterior subtalar joint surface. Böhler's angle, or the "Tuber Angle", is another normal
248:
The most common symptom is pain over the heel area, especially when the heel is palpated or squeezed. Patients usually have a history of recent trauma to the area or fall from a height. Other symptoms include: inability to bear weight over the involved foot, limited mobility of the foot, and limping.
507:
The first phase of the rehabilitation after surgery includes keeping the foot elevated and iced for the first 2 days after the operation. After those 2 days, using crutches or a wheelchair in which there is no weight applied to the affected foot is recommended to getting around. If no operation was
257:
Evaluating soft-tissue involvement is the most important aspect of the clinical examination because of its association with patient outcome. Skin blisters may become infected if medical attention is delayed, which can lead to necrotizing fasciitis or osteomyelitis, causing permanent damage to muscle
290:. In addition, footwear can influence forces that may cause a calcaneal fracture and can prevent them as well. A 2012 study conducted by Salzler showed that the increasing trend toward minimalist footwear or running barefoot can lead to a variety of stress fractures including that of the calcaneus.
462:
Displaced intra-articular fractures require surgical intervention within 3 weeks of fracture, before bone consolidation has occurred. Conservative surgery consists of closed reduction with percutaneous fixation. This technique is associated with less wound complications, better soft tissue healing
266:
Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction (Soeur, 1975). These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the
384:
groups these fractures into four types based on the location of the fracture at the posterior articular surface. Extra-articular fractures are less common and may be located anywhere outside the subtalar joint. Extra-articular fractures are categorized depending on whether the involvement of the
458:
Non-surgical treatment is for extra-articular fractures and
Sanders Type I intra-articular fractures, provided that the calcaneal weight-bearing surface and foot function are not compromised. Physicians may choose to perform closed reduction with or without fixation (casting), or fixation alone
348:
is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures. Axial and coronal views are obtained for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints.
343:
Conventional radiography is usually the initial assessment tool when a calcaneal fracture is suspected. Recommended x-ray views are (a) axial, (b) anteroposterior, (c) oblique and (d) views with dorsiflexion and internal rotation of the foot. However, conventional radiography is limited for
375:
The calcaneus, also known as the heel bone, is the largest of the tarsal bones and articulates with the cuboid bone anteriorly and the talus bone superiorly. It is responsible for transmitting the majority of the body's weight from the talus bone to the ground.
228:
without weight bearing for around eight weeks. If the bones are not properly aligned surgery is generally required. Returning the bones to their normal position results in better outcomes. Surgery may be delayed a few days as long as the skin remained intact.
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of the ankle, and a combination of the two motions to create a circular foot motion. Exercises that allow slight to full body weight to be used in the final phases include stepping forward then back, side-stepping, and leg stand.
379:
Calcaneal fractures are categorized as intra-articular or extra-articular on the basis of subtalar joint involvement. Intra-articular fractures are more common and involve the posterior talar articular facet of the calcaneus. The
459:(without reduction), depending on the individual case. Recommendations include no weight-bearing for a few weeks followed by range-of-motion exercises and progressive weight bearing for a period of 2–3 months.
322:
removes a portion of the bone as it rescinds) and diabetes mellitus. The diabetic population is more susceptible to the risks of fracture and potential healing complications and infection that may lead to
487:
Rehabilitation for a calcaneal fractures is dependent on whether surgery was required or not. Both types of rehabilitation require three phases in which only the first phase is different.
1267:
1150:"Minimally invasive surgery for intra-articular calcaneus fractures: a 9-year, single-center, retrospective study of a standardized technique using a 2-point distractor"
310:, coupled with exercise and by being a non-smoker. A study by Cheng et al. in 1997, showed that greater bone density indicated less risk for fractures in the calcaneus.
1284:
Hatzokos I, Karataglis D, Papadopoulos P, Dimitriou C, Christodoulou A, Pournaras J (January 2006). "Treatment of intra-articular comminuted os calcis fractures".
278:
Unfortunately, the prevention of falls and automobile accidents is limited and applies to unique circumstances that should be avoided. The risk of muscular
700:
Berry GK, Stevens DG, Kreder HJ, McKee M, Schemitsch E, Stephen DJ (April 2004). "Open fractures of the calcaneus: a review of treatment and outcome".
936:
Kathol MH, el-Khoury GY, Moore TE, Marsh JL (September 1991). "Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus".
1385:
1050:
318:
In 1991, Kathol conducted a study which showed a correlation between calcaneal insufficiency avulsion fractures (a fracture in which the
746:
Heier KA, Infante AF, Walling AK, Sanders RW (December 2003). "Open fractures of the calcaneus: soft-tissue injury determines outcome".
836:
1260:
267:
resulting forces can lead to the trauma of fracture. Overlooked aspects of what can lead to a calcaneal fracture are the roles of
236:. Undisplaced fractures may heal in around three months while more significant fractures can take two years. Difficulties such as
1075:
580:
999:
Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011). "Multidetector CT evaluation of calcaneal fractures".
520:
is derived from the fact that a lover may jump from great heights while trying to escape from the lover's spouse.
446:
Type B involve the middle calcaneus. This includes the sustentaculum tali, trochlear process and lateral process.
852:
Salzler MJ, Bluman EM, Noonan S, Chiodo CP, de Asla RJ (April 2012). "Injuries observed in minimalist runners".
1327:
Lee P, Hunter TB, Taljanovic M (2004). "Musculoskeletal colloquialisms: how did we come up with these names?".
439:
Extra-articular fractures include all fractures that do not involve the posterior facet of the subtalar joint.
421:
Type III fractures consist of two intra-articular fractures that divide the calcaneus into 3 articular pieces.
1491:
1202:
Lewis, Sharon R.; Pritchard, Michael W.; Solomon, Joshua L.; Griffin, Xavier L.; Bruce, Julie (2023-11-07).
897:"Calcaneal bone mineral density predicts fracture occurrence: a five-year follow-up study in elderly people"
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210:
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95:
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Exercises that can be used for the range of motion phase can include eversion and inversion of the ankle,
471:
397:
381:
784:
Soeur R, Remy R (November 1975). "Fractures of the calcaneus with displacement of the thalamic portion".
407:
Type II fractures consist of a single intra-articular fracture that divides the calcaneus into 2 pieces.
400:
system is the most commonly used system for categorizing intra-articular fractures. There are 4 types:
819:
Stoller DW, Tirman PF, Bredella M (2004). "Ankle and foot, osseous fractures, calcaneal fractures".
613:
Palmersheim K, Hines B, Olsen BL (April 2012). "Calcaneal fractures: update on current treatments".
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1309:
877:
725:
232:
About 2% of all fractures are calcaneal fractures. However, they make up 60% of fractures of the
82:
75:
1375:
1148:
Rodemund C, Krenn R, Kihm C, Leister I, Ortmaier R, Litzlbauer W, et al. (November 2020).
665:
Richman JD, Barre PS (June 1986). "The plantar ecchymosis sign in fractures of the calcaneus".
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It usually occurs when a person lands on their feet following a fall from a height or during a
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1344:
1301:
1241:
1223:
1204:"Surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures"
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Type C involve the posterior calcaneus, the posterior tuberosity and medial tubercle included.
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Cheng S, Suominen H, Sakari-Rantala R, Laukkanen P, Avikainen V, Heikkinen E (July 1997).
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194:(heel bone). Symptoms may include pain, bruising, trouble walking, and deformity of the
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Type IV fractures consist of fractures with more than three intra-articular fractures.
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1045:(Seventh ed.). Philadelphia, PA: Elsevier Health Sciences. p. 562.
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1039:"Disorders of the foot and ankle, Section 18: Trauma: Calcaneous Fractures"
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Type I fractures are non-displaced fractures (displacement < 2 mm).
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Type IIIAB: two fracture lines are present, one lateral and one central.
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visualization of calcaneal anatomy, especially at the subtalar joint. A
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Type IIIBC: two fracture lines are present, one central and one medial.
427:
Type IIIAC: two fracture lines are present, one lateral and one medial.
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calcaneus is anterior (Type A), middle (Type B) or posterior (Type C).
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327:. Diabetes can be regulated and prevented through diet and exercise.
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213:. Diagnosis is suspected based on symptoms and confirmed by
393:. A decreased angle is indicative of a calcaneal fracture.
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Type IIB: fracture occurs on central aspect of calcaneus.
410:
Type IIA: fracture occurs on lateral aspect of calcaneus.
302:
bone loss can be prevented through an adequate intake of
224:
If the bones remain normally aligned treatment may be by
416:
Type IIC: fracture occurs on medial aspect of calcaneus.
41:
Heel bone fracture, lover's fracture, Don Juan fracture
748:
The
Journal of Bone and Joint Surgery. American Volume
240:
and decreased range of motion of the foot may remain.
786:
The
Journal of Bone and Joint Surgery. British Volume
1399:
298:
Bone mineral density decreases with increasing age.
111:
Landing on the feet following a fall from a height,
1455:
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1380:(3rd ed.). Lippincott Williams & Wilkins.
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118:
107:
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81:
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573:"Calcaneus (Heel Bone) Fractures-OrthoInfo - AAOS"
87:Pain, bruising, trouble walking, deformity of the
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992:
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1030:
8:
779:
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1208:The Cochrane Database of Systematic Reviews
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667:Clinical Orthopaedics and Related Research
198:. It may be associated with breaks of the
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615:Clinics in Podiatric Medicine and Surgery
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1261:"Calcaneal Fracture and Rehabilitation"
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103:, decreased range of motion of the foot
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1078:from the original on October 14, 2017
443:Type A involve the anterior calcaneus
286:and weight-bearing exercise, such as
7:
1377:Fundamentals of Diagnostic Radiology
1041:. In Miller MD, Thompson SR (eds.).
976:The Lecturio Medical Concept Library
901:Journal of Bone and Mineral Research
827:. Salt Lake City: Amirsys. pp.
475:Calcaneal fracture neutral position
339:A fractured calcaneus as seen on CT
25:
583:from the original on 18 June 2017
1273:from the original on 2016-03-06.
823:Diagnostic imaging: orthopaedics
760:10.2106/00004623-200312000-00002
714:10.1097/00005131-200404000-00002
679:10.1097/00003086-198606000-00022
1043:Miller's Review of Orthopaedics
1037:Kadakia AR, Seybold JD (2016).
950:10.1148/radiology.180.3.1871285
1220:10.1002/14651858.CD008628.pub3
854:Foot & Ankle International
1:
1154:BMC Musculoskeletal Disorders
1132:Calcaneus Fractures~treatment
702:Journal of Orthopaedic Trauma
1298:10.3928/01477447-20060101-15
1099:"Lorenz Böhler: in memoriam"
914:10.1359/jbmr.1997.12.7.1075
1508:
1167:10.1186/s12891-020-03762-9
798:10.1302/0301-620X.57B4.413
168:3 month to 2 year recovery
1374:Brant W, Helms C (2007).
627:10.1016/j.cpm.2012.01.007
54:
45:
282:can be reduced through
211:motor vehicle collision
113:motor vehicle collision
1259:Godges J, Klingman R.
1097:Bohler J (July 1973).
1066:Radswiki; et al.
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398:Sanders classification
382:Sanders classification
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1266:. Kaiser Permanente.
1103:The Journal of Trauma
866:10.3113/FAI.2012.0262
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1341:10.1148/rg.244045015
1068:"Calcaneal fracture"
1013:10.1148/rg.311105036
972:"Diabetes Mellitus"
649:Calcaneus Fractures
512:Society and culture
124:Based on symptoms,
1456:External resources
621:(2): 205–20, vii.
577:orthoinfo.aaos.org
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244:Signs and symptoms
184:calcaneal fracture
76:emergency medicine
33:Calcaneal fracture
18:Calcaneus fracture
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1387:978-0-7817-6135-2
1052:978-0-323-39042-2
754:(12): 2276–2282.
288:strength training
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120:Diagnostic method
27:Medical condition
16:(Redirected from
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1335:(4): 1009–1027.
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1214:(11): CD008628.
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579:. January 2016.
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280:stress fractures
176:~2% of fractures
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58:of a fractured
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