Calcaneal fracture
A break of the heel bone, often from high-energy trauma.
A calcaneal fracture is a break in the heel bone. Common signs include pain, bruising, difficulty walking, and a misshapen heel. Such fractures often occur alongside injuries to the hip or spine. While they account for only about 2% of all fractures, they represent 60% of fractures affecting the midfoot.
**Signs and symptoms** The primary symptom is pain in the heel, especially when pressed or squeezed. Patients typically report a recent trauma, such as a fall from height. Other signs include an inability to put weight on the foot, limited foot movement, and a limp. On examination, there may be swelling, redness, and bruising. A bruise that spreads to the sole of the foot is known as Mondor sign and is a telltale indicator of a calcaneal fracture. The heel may also appear widened due to swelling from displacement of the bone’s outer edge. Evaluating the soft tissues is crucial because of the risk of serious complications.
**Complications** Assessing soft-tissue damage is the most critical part of the exam, as it strongly influences the outcome. Skin blisters can become infected if treatment is delayed, potentially leading to necrotizing fasciitis or osteomyelitis, which can permanently damage muscle or bone. Ligament and tendon injuries, such as damage to the Achilles tendon in posterior fractures, should also be checked. Because these fractures often result from falls, other injuries are common. About 10% of patients also have vertebral compression fractures. A thorough trauma assessment should rule out injuries to the tibia, knee, femur, hip, and head through history and physical exam.
**Cause** Calcaneal fractures typically result from shearing stress combined with compressive and rotary forces. These forces commonly occur when someone falls from a height, is in a car accident, or experiences muscular stress. Overlooked contributing factors include osteoporosis and diabetes. Preventing falls and car accidents is difficult, but the risk of stress fractures from muscle overuse can be reduced with stretching and weight-bearing exercises like strength training. Footwear also plays a role; a 2012 study by Salzler found that the trend toward minimalist shoes or barefoot running can increase the risk of stress fractures, including those of the calcaneus.
**Osteoporosis** Bone density decreases with age. Osteoporotic bone loss can be slowed by adequate intake
- field
- Orthopedic trauma
- known_for
- Fracture of the heel bone, often from falls or motor vehicle collisions
- diagnosis
- X-rays or CT scanning
- treatment
- Casting for undisplaced fractures; surgery for displaced fractures
- complications
- Arthritis, decreased range of motion, necrotizing fasciitis, osteomyelitis
Lore & Background
Calcaneal fractures usually occur when a person lands on their feet following a fall from a height or during a motor vehicle collision. Diagnosis is suspected based on symptoms and confirmed by X-rays or CT scanning. The most common symptom is pain over the heel area, especially when the heel is palpated or squeezed. A hematoma extending to the sole of the foot is called 'Mondor Sign' and is pathognomonic for calcaneal fracture.
Reader's Guide
Calcaneal fractures are significant because they represent about 2% of all fractures but 60% of mid foot fractures. They are often associated with other injuries such as vertebral compression fractures, which occur in approximately 10% of patients. Treatment depends on alignment: if bones remain normally aligned, casting without weight bearing for around eight weeks may suffice; if not properly aligned, surgery is generally required. Undisplaced fractures may heal in around three months, while more significant fractures can take two years. Difficulties such as arthritis and decreased range of motion of the foot may remain. The Sanders classification system is the most commonly used system for categorizing intra-articular fractures. Soft tissue involvement is the most important aspect of clinical examination because of its association with serious complications like necrotizing fasciitis or osteomyelitis.
Did You Know?
- About 2% of all fractures are calcaneal fractures, but they make up 60% of fractures of the mid foot bones.
- A hematoma extending to the sole of the foot is called 'Mondor Sign' and is pathognomonic for calcaneal fracture.
- Vertebral compression fractures occur in approximately 10% of patients with calcaneal fractures.
- Böhler's angle is normally 25° to 40°; a decreased angle is indicative of a calcaneal fracture.
Frequently Asked Questions
Who is Calcaneal fracture?
Calcaneal fracture is a break in the heel bone, typically produced by high-energy impacts such as a fall from height or a motor-vehicle collision. It is a well-known member of the orthopedic-trauma family.
What are Calcaneal fracture's powers/role?
Its signature move is deep heel pain that sharpens with pressure, paired with bruising, a visibly deformed heel, and an inability to bear weight. It frequently teams up with hip or spine injuries during the same traumatic event.
How does Calcaneal fracture's story end?
If the bone fragments remain aligned, a cast is usually sufficient to guide healing. When the pieces have shifted out of place, surgeons step in to realign and stabilize the bone with hardware.
Why is Calcaneal fracture important?
Although it represents only about 2% of all bone breaks, it accounts for roughly 60% of midfoot fractures, making it a dominant force in that region. Diagnosis is confirmed primarily through X-rays or CT scanning.
What are Calcaneal fracture's known weaknesses?
After healing, it can leave behind arthritis, a reduced range of motion, or serious infections such as osteomyelitis and necrotizing fasciitis. These long-term complications are what make its fanbase both loyal and cautious.
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