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Calcaneal fracture

Assoc Prof Craig Hacking and Radswiki et al.

Calcaneal fractures are the most common tarsal fracture and can occur in a variety of settings.

The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3.

Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8:

  1. extra-articular: 25-30%
  2. intra-articular: 70-75%
    • intra-articular body fracture

The calcaneus is also a common site of stress fractures, occurring in the posterosuperior aspect.

Another method of classification is as 

  • type A fractures: the anterior process of the calcaneus is fractured
  • type B: fracture of the mid calcaneus, trochlear process, and sustentaculum tali
  • type C: fracture of the posterior tuberosity
  • Böhler's angle is the angle between two tangent lines drawn across the anterior and posterior borders of the calcaneus in the lateral view. When Böhler's angle becomes <20º it indicates a calcaneal fracture. On a lateral radiograph, an angle of Gissane of >130° suggests depression of the posterior facet of the subtalar joint.
  • normal Böhler's angle does not exclude a fracture and is unreliable in children 9
  • calcaneal stress fracture shows vertical linear sclerotic appearance 9

CT is the modality of choice to evaluate calcaneal fracture. It can show the extent and extra- or intra-articular components of the fracture and hematoma along the sole of the foot (Mondor sign). Intra-articular fractures are often classified using the Sander classification system, which is one of the only systems that correlate well with patient outcome.

If bilateral calcaneal fractures are seen, then the spine should also be evaluated for fracture as the mechanism of injury is often a large load to the axial skeleton, such as jumping from a second-story window.

If an intraarticular calcaneal fracture is seen, the images should be scrutinized for a lateral malleolar fleck sign (ankle), which raises the likelihood of peroneal tendon instability 10.


Article information

rID: 12879
Synonyms or Alternate Spellings:
  • Calcaneal fractures
  • Fractures of the calcaneus
  • Fracture involving the calcaneus
  • Fractured calcaneus
  • Fracture of calcaneus

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Cases and figures

  • Case 1: intra-articular fracture
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  • Case 2: extra-articular fracture
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  • Case 3: tuberosity avulsion fracture
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  • Case 4: anterior process fracture
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  • Case 5: axial projection
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  • Case 6: body fracture (MRI)
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  • Case 7: stress
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  • Case 8: calcaneal anterior process fracture
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  • Case 9: extra-articular calcaneal fracture
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  • Case 10: anterior process fracture
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  • Case 11: intra-articular
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  • Case 12: anterior calcaneal process fracture
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  • Case 13: comminuted fracture
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  • Case 14: anterior process
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