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204: CALCANEUS FRACTURE

Jennifer Cabrera, DPT, GCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Heel fracture

  • Lover’s fracture

  • Don Juan fracture

ICD-9-CM CODES

  • 825.0 Fracture of calcaneus closed

  • 825.1 Fracture of calcaneus open

ICD-10-CM CODES

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

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

PREFERRED PRACTICE PATTERN

  • 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated with Fracture1

PATIENT PRESENTATION

A 43-year-old man fell off of a ladder from approximately 7 ft high and landed completely on one foot. He reported immediate pain in the foot with inability to bear weight. He presented with constant pain, swelling of the foot and ankle and worsening pain with all ankle/foot movements. Patient presents on the day of injury as a direct access patient. The patient is still unable to bear weight. Patient is positive in the Ottawa ankle rules and referred to the emergency room for an X-ray. Radiographs showed a calcaneus fracture.

KEY FEATURES

Description

  • Fracture2

  • Any defect in continuity of the calcaneus3

  • Displaced (calcaneus is moved on either side of fracture) or nondisplaced (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 fracture4

    • More common

    • Posterior talar articular facet of the calcaneus

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

FIGURE 204-1

Axial CT section showing a fracture of the calcaneus caused by an axial loading mechanism. (From Doherty GM. Current Diagnosis & Treatment: Surgery. 13th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Diagnosis usually made by clinical examination

  • May not be fracture, but plantar fasciitis or heel spur

  • Böhler 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 affect leg length with compression of the fracture

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Pain with weight bearing

  • Point tenderness

  • Increased pain on weight ...

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