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Calcaneus fractures

Robert L Hatch, MD, MPH
Cooper Dean, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Calcaneal fractures are relatively uncommon, comprising 1 to 2 percent of all fractures, but important because they can lead to long-term disability. Axial loading of the foot following a fall from a height is the most common mechanism for severe calcaneal fractures. There are two broad categories of calcaneal fractures: extraarticular and intraarticular. Extraarticular fractures are generally more straightforward to assess and manage. Patients with calcaneus fractures often have multiple concurrent injuries, and it is important to consider this possibility when evaluating patients.

The initial assessment of calcaneus fractures, differentiation of intraarticular from extraarticular fractures, and the nonoperative management of appropriate extraarticular fractures are reviewed here. A brief overview of the assessment and management of intraarticular fractures is also included. General fracture management and other foot fractures are discussed separately. (See "General principles of acute fracture management" and "General principles of definitive fracture management" and "General principles of fracture management: Bone healing and fracture description" and "General principles of fracture management: Early and late complications" and "Talus fractures".)


The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [1]. The peak incidence occurs in younger males [2]. Most calcaneal fractures are occupational, and are caused by axial loading from a fall [2]. The majority are displaced intraarticular fractures (60 to 75 percent) [2]. According to a retrospective review of 752 calcaneal fractures occurring over a 10-year period, the annual incidence of calcaneal fractures is 11.5 per 100,000, with a male to female ratio of 2.4:1 [3]. Seventy-two percent of these fractures resulted from falls.


The foot has three divisions: the hindfoot (calcaneus and talus), midfoot (navicular, cuboid, and cuneiforms), and forefoot (metatarsals and phalanges) (figure 1A-C). The calcaneus is the largest tarsal bone and supports the axial load from the weight of the body (figure 2 and figure 3 and figure 4).

Superiorly, the calcaneus has three facets (anterior, middle and posterior), which articulate with the talus to form the subtalar joint (figure 5). The posterior facet is the largest of the three facets and the major weightbearing surface of the calcaneus. The middle and posterior facets are separated from one another by a sulcus. The middle facet is reinforced by the sustentaculum tali, a projection of the calcaneus that articulates with the medial portion of the talus. The flexor hallucis longus tendon passes under the sustentaculum.


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Literature review current through: Sep 2016. | This topic last updated: Aug 9, 2016.
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