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Calcaneus fractures

Robert L Hatch, MD, MPH
Cooper Dean, MD
Karina Reyner Pauly, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
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: Nov 2017. | This topic last updated: Aug 09, 2016.
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  1. Eiff MP, Hatch RL. Fracture Management for Primary Care, 3rd, Elsevier Saunders, Philiadelphia 2012.
  2. Sanders RW, Clare MP. Calcaneous fractures. In: Rockwood and Green's Fractures in Adults, 7th, Bucholz, RW, Heckman JD, Court-Brown CM, Tornetta P (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.2064.
  3. Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot (Edinb) 2009; 19:197.
  4. Daftary A, Haims AH, Baumgaertner MR. Fractures of the calcaneus: a review with emphasis on CT. Radiographics 2005; 25:1215.
  5. Albert MJ, Waggoner SM, Smith JW. Internal fixation of calcaneus fractures: an anatomical study of structures at risk. J Orthop Trauma 1995; 9:107.
  6. Oh SJ, Kwon KH, Hah JS, et al. Lateral plantar neuropathy. Muscle Nerve 1999; 22:1234.
  7. Baumhauer JF, Manoli A 2nd. Principles of management of the severely traumatized foot and ankle. Instr Course Lect 2002; 51:159.
  8. Schweitzer ME, Karasic D. The foot. In: Radiology of Skeletal Trauma, 3rd, Rogers LF (Ed), Churchill Livingstone, Philadelphia 2002. p.1319.
  9. Isaacs JD, Baba M, Huang P, et al. The diagnostic accuracy of Böhler's angle in fractures of the calcaneus. J Emerg Med 2013; 45:879.
  10. Boyle MJ, Walker CG, Crawford HA. The paediatric Bohler's angle and crucial angle of Gissane: a case series. J Orthop Surg Res 2011; 6:2.
  11. Germann CA, Perron AD, Miller MD, et al. Orthopedic pitfalls in the ED: calcaneal fractures. Am J Emerg Med 2004; 22:607.
  12. Kalsi R, Dempsey A, Bunney EB. Compartment syndrome of the foot after calcaneal fracture. J Emerg Med 2012; 43:e101.
  13. Myerson M, Manoli A. Compartment syndromes of the foot after calcaneal fractures. Clin Orthop Relat Res 1993; :142.
  14. Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res 2001; :7.
  15. Gardner MJ, Nork SE, Barei DP, et al. Secondary soft tissue compromise in tongue-type calcaneus fractures. J Orthop Trauma 2008; 22:439.
  16. Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician 2002; 66:785.
  17. Degan TJ, Morrey BF, Braun DP. Surgical excision for anterior-process fractures of the calcaneus. J Bone Joint Surg Am 1982; 64:519.
  18. Norfray JF, Rogers LF, Adamo GP, et al. Common calcaneal avulsion fracture. AJR Am J Roentgenol 1980; 134:119.
  19. Squires B, Allen PE, Livingstone J, Atkins RM. Fractures of the tuberosity of the calcaneus. J Bone Joint Surg Br 2001; 83:55.
  20. Della Rocca GJ, Nork SE, Barei DP, et al. Fractures of the sustentaculum tali: injury characteristics and surgical technique for reduction. Foot Ankle Int 2009; 30:1037.
  21. Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury 2004; 35:443.
  22. Guerado E, Bertrand ML, Cano JR. Management of calcaneal fractures: what have we learnt over the years? Injury 2012; 43:1640.
  23. Gougoulias N, Khanna A, McBride DJ, Maffulli N. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull 2009; 92:153.
  24. Jiang N, Lin QR, Diao XC, et al. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. Int Orthop 2012; 36:1615.
  25. Poeze M, Verbruggen JP, Brink PR. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature. J Bone Joint Surg Am 2008; 90:1013.
  26. Bruce J, Sutherland A. Surgical versus conservative interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev 2013; :CD008628.
  27. Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014; 349:g4483.
  28. Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician 2011; 84:909.
  29. Salzler MJ, Bluman EM, Noonan S, et al. Injuries observed in minimalist runners. Foot Ankle Int 2012; 33:262.
  30. Goulart M, O'Malley MJ, Hodgkins CW, Charlton TP. Foot and ankle fractures in dancers. Clin Sports Med 2008; 27:295.
  31. Sormaala MJ, Niva MH, Kiuru MJ, et al. Stress injuries of the calcaneus detected with magnetic resonance imaging in military recruits. J Bone Joint Surg Am 2006; 88:2237.
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