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.
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.
- 1. Marinček B, Dondelinger RF. Emergency radiology, imaging and intervention. Springer Verlag. (2007) ISBN:354026227X. Read it at Google Books - Find it at Amazon
- 2. Daftary A, Haims AH, Baumgaertner MR. Fractures of the calcaneus: a review with emphasis on CT. Radiographics. 25 (5): 1215-26. doi:10.1148/rg.255045713 - Pubmed citation
- 3. Badillo K, Pacheco JA, Padua SO et-al. Multidetector CT evaluation of calcaneal fractures. Radiographics. 31 (1): 81-92. doi:10.1148/rg.311105036 - Pubmed citation
- 4. Heger L, Wulff K, Seddiqi MS. Computed tomography of calcaneal fractures. AJR Am J Roentgenol. 1985;145 (1): 131-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 5. Matherne TH, Tivorsak T, Monu JU. Calcaneal fractures: what the surgeon needs to know. Curr Probl Diagn Radiol. 36 (1): 1-10. doi:10.1067/j.cpradiol.2006.07.006 - Pubmed citation
- 6. Wechsler RJ, Schweitzer ME, Karasick D et-al. Helical CT of calcaneal fractures: technique and imaging features. Skeletal Radiol. 1998;27 (1): 1-6. - Pubmed citation
- 7. Levine AM, Jupiter JB et-al. Skeletal Trauma. Saunders. (2009) ISBN:1416022201. Read it at Google Books - Find it at Amazon
- 8. Mandell J. Core Radiology. Cambridge University Press. (2013) ISBN:1107679680. Read it at Google Books - Find it at Amazon