Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Heel fractureLover’s fractureDon Juan fracture ++ 825.0 Fracture of calcaneus closed825.1 Fracture of calcaneus open ++ S92.009A Unspecified fracture of unspecified calcaneus, initial encounter for closed fractureS92.009B Unspecified fracture of unspecified calcaneus, initial encounter for open fracture ++ 4G: Impaired Joint Mobility, Muscle Performance, and Range of Motion Associated With Fracture1 +++ Description ++ FractureAny defect in continuity of the calcaneusDisplaced (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 fractureInvolvement of the calcaneus anterior (type A), middle (type B), posterior (type C)Intra-articular calcaneal fractureMore commonPosterior talar articular facet of the calcaneusSanders system of classification categorizes into 4 types based on location at posterior articular surface +++ Essentials of Diagnosis ++ Diagnosis usually made by clinical examinationMay not be fracture but plantar fasciitis or heel spurBöhler'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 fractureAngle 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 boneMay effect leg length with compression of the fracture +++ Signs and Symptoms ++ Pain with weight bearingPoint tendernessIncreased pain on weight bearingEdemaRednessEcchymosisFracture blisterLoss of general functionLoss of active mobilityMuscle guarding with passive movementHeel deformityMondor sign: hematoma going to the bottom of the foot +++ Functional Implications ++ Pain with standingAntalgic gaitInability to bear weight on injured lower extremityPain with open or closed chain ankle movements (driving) +++ Possible Contributing Causes ++ History of high-impact activitiesTraumaHistory of fallsOsteoporosis +++ Differential Diagnosis ++ Stress fractureHeel spurPlantar fasciitisAchilles tendonitis +++ Imaging ++ X-ray for fracture, often limited viewCT scan for detailed imagingBone scan if stress fracture is suspected +++ Diagnostic Procedures ++ Calcaneal squeeze test to produce heel pain ++ Hop-to gait sequence or decreased stance time on injured lower extremity secondary to painExposed bone in cases of open and displaced fractureIntegumentary deformity over underlying fractureIf vascular structures involved, foot will appear cool and paleIf neurologic ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth