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

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

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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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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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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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Imaging

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Diagnostic Procedures

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  • Calcaneal squeeze test to produce heel pain

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  • 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

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  • To radiology for imaging, ...

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