Skip to Main Content

++

  • Heel fracture
  • Lover’s fracture
  • Don Juan fracture

++

  • 825.0 Fracture of calcaneus closed
  • 825.1 Fracture of calcaneus open

++

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

++
++

Description

++

  • 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

++

Essentials of Diagnosis

++

  • 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

++

General Considerations

++

  • 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

++

Signs and Symptoms

++

  • 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

++

Functional Implications

++

  • Pain with standing
  • Antalgic gait
  • Inability to bear weight on injured lower extremity
  • Pain with open or closed chain ankle movements (driving)

++

Possible Contributing Causes

++

  • History of high-impact activities
  • Trauma
  • History of falls
  • Osteoporosis

++

Differential Diagnosis

++

  • Stress fracture
  • Heel spur
  • Plantar fasciitis
  • Achilles tendonitis

++

Imaging

++

++

Diagnostic Procedures

++

  • Calcaneal squeeze test to produce heel pain

++

  • Hop-to gait sequence or decreased stance time on injured lower extremity secondary to pain
  • Exposed bone in cases of open and displaced fracture
  • Integumentary deformity over underlying fracture
  • If vascular structures involved, foot will appear cool and pale
  • If neurologic structures involved, patient will report numbness and decreased ability to move the foot and toes

++

  • To radiology for imaging, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.