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Condition/Disorder Synonyms

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  • Heel fracture

  • Lover's fracture

  • Don Juan fracture

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ICD-9-CM Codes

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  • 825.0 Fracture of calcaneus closed

  • 825.1 Fracture of calcaneus open

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ICD-10-CM Codes

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  • S92.009A Unspecified fracture of unspecified calcaneus, initial encounter for closed fracture

  • S92.009B Unspecified fracture of unspecified calcaneus, initial encounter for open fracture

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Preferred Practice Pattern

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Key Features

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Description

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  • Fracture

  • Any defect in continuity of the calcaneus

  • Displaced (calcaneus is moved on either side of fracture) or non-displaced (calcaneus has not moved)

  • Closed (skin is intact)

  • Open (skin is breached)

  • Extra-articular calcaneal fracture

    • Involvement of the calcaneus anterior (type A), middle (type B), posterior (type C)

  • Intra-articular calcaneal fracture

    • More common

    • Posterior talar articular facet of the calcaneus

    • Sanders system of classification categorizes into 4 types based on location at posterior articular surface

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination

  • May not be fracture but plantar fasciitis or heel spur

  • Böhler's angle (Tuber Angle)

    • Vertex between a line from the top of the posterior articular facet to the top of the posterior tuberosity and a line from the top of the posterior tuberosity to the top of the anterior articular facet.

    • Angle < 20 degrees suggests drop of the posterior facet and possible calcaneal fracture

  • Angle of Gissane (Critical Angle)

    • Downward and upward slope of the calcaneal superior surface

    • Angle > 130 degrees suggests fracture of the posterior subtalar joint surface

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General Considerations

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  • Occurs most often during high-energy collisions (fall from height, motor vehicle accident)

  • Most frequently fractured tarsal bone

  • May effect leg length with compression of the fracture

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Clinical Findings

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Signs and Symptoms

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  • Pain with weight bearing

  • Point tenderness

  • Increased pain on weight bearing

  • Edema

  • Redness

  • Ecchymosis

  • Fracture blister

  • Loss of general function

  • Loss of active mobility

  • Muscle guarding with passive movement

  • Heel deformity

  • Mondor sign: hematoma going to the bottom of the foot

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Functional Implications

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  • Pain with standing

  • Antalgic gait

  • Inability to bear weight on injured lower extremity

  • Pain with open or closed chain ankle movements (driving)

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Possible Contributing Causes

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  • History of high-impact activities

  • Trauma

  • History of falls

  • Osteoporosis

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Differential Diagnosis

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  • Stress fracture

  • Heel spur

  • Plantar fasciitis

  • Achilles tendonitis

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray for fracture, often limited view

  • CT scan for detailed imaging

  • Bone scan if stress fracture is suspected

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Diagnostic Procedures

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  • Calcaneal squeeze test to produce heel pain

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Findings and Interpretation

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  • Hop-to gait sequence or decreased stance time on injured ...

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