Anterior calcaneal process fracture

Case contributed by Henry Knipe
Diagnosis certain


Tripped over cat one day ago. Ongoing pain and unable to weight bear.

Patient Data

Age: 45 years
Gender: Female

Cortical irregularity in the region of the anterior process of the calcaneum. Dorsal soft tissue swelling. No traumatic malalignment with chronic hallux valgus and first metatarsophalangeal degenerative change.

Undisplaced fracture of the anterior calcaneal process with extension to the articular surface of the calcaneocuboid joint. Dorsal foot soft tissue swelling.

Case Discussion

Anterior calcaneal process fractures are the result of an inversion and plantarflexion injury. It represents an avulsion fracture of the bifurcate ligament. The fracture is classified as an extra-articular calcaneal fracture (does not involve subtalar joint) but can extend to the calcaneocuboid joint. 

This diagnosis can be challenging on plain x-rays, and the anterior calcaneal process should be a check area on foot x-rays, especially in exams! 

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