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:
- extra-articular: 25-30%
- 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 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.
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 haematoma along sole of 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.
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