Anterior process of calcaneus fracture

Case contributed by Chris O'Donnell

Presentation

Painful right foot following a twisting (inversion) injury

Patient Data

Age: 25 years
Gender: Male

Soft tissue swelling overlying the dorsal talus and navicula but no obvious fracture.  No ankle joint effusion.

CT scan performed as foot very painful with swelling on radiograph but no fracture seen

ct

Minimally displaced but slightly comminuted fracture of the anterior process calcaneus (arrows) with considerable overlying soft tissue swelling involving the subcutaneous tissues and bifurcate ligament.

Case Discussion

These fractures can be missed on the x-ray either because they are obscured (as in this case) or not looked for/recognized.  They represent an avulsion at the origin of the bifurcate ligament joining the antero-superior calcaneus to the navicula and cuboid.  If not treated by immobilization or fixation they can produce long term foot pain due to non-union.  The marked surrounding soft tissue swelling in an indication of the trauma involved in producing such a fracture.

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