Calcaneal fracture

Last updated: February 17, 2023

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Fractures of the calcaneus are caused by acute trauma or chronic load-bearing on the foot. Fractures may be extraarticular (e.g., avulsion of the calcaneal process) but more commonly involve an intraarticular surface (e.g., the subtalar joint). Acute calcaneal fractures are typically caused by a high-energy impact to the heel (e.g., fall from a significant height, motor vehicle accident); a low-energy impact may cause a fracture in an osteoporotic or diseased bone. Clinical manifestations of an acute fracture include heel pain and plantar ecchymosis. X-rays typically confirm the diagnosis, but a CT should be obtained if clinical suspicion for an acute fracture is high and the initial x-ray findings are negative. Orthopedics should be consulted early, and the affected extremity should be elevated and placed in a bulky dressing. Surgical treatment may be required for displaced or intraarticular fractures.

For details about stress fractures in the calcaneus, see “Calcaneal stress fractures.”

  • High-energy axial impact on normal bone (most common) [1][2]
  • Low-energy axial impact on osteoporotic or diseased bone [3]

Over 75% of patients with an acute calcaneal fracture have another significant injury. [2]

Symptoms of a calcaneal fracture may be overshadowed by symptoms from other larger injuries. [1]

Initial management [1][3][5]

Definitive treatment [1][3][5]

Intraarticular fractures have the highest risk of long-term disability. [1][3]

We list the most important complications. The selection is not exhaustive.

  1. Sherman SC. Simon's Emergency Orthopedics, 8th edition. McGraw Hill Professional ; 2018
  2. Bohl DD, Ondeck NT, Samuel AM, et al. Demographics, Mechanisms of Injury, and Concurrent Injuries Associated With Calcaneus Fractures: A Study of 14 516 Patients in the American College of Surgeons National Trauma Data Bank. Foot Ankle Spec. 2016; 10 (5): p.402-410. doi: 10.1177/1938640016679703 . | Open in Read by QxMD
  3. Trompeter A, Razik A, Harris M. Calcaneal fractures: Where are we now?. Strategies Trauma Limb Reconstr. 2017; 13 (1): p.1-11. doi: 10.1007/s11751-017-0297-3 . | Open in Read by QxMD
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Bernstein J, Ahn J. In Brief: Fractures in Brief: Calcaneus. Clin Orthop Relat Res. 2010; 468 (12): p.3432-3434. doi: 10.1007/s11999-010-1345-1 . | Open in Read by QxMD
  6. Maskill JD, Bohay DR, Anderson JG. Calcaneus Fractures: A Review Article. Foot Ankle Clin. 2005; 10 (3): p.463-489. doi: 10.1016/j.fcl.2005.03.002 . | Open in Read by QxMD
  7. Park YH, Lee JW, Hong JY, Choi GW, Kim HJ. Predictors of compartment syndrome of the foot after fracture of the calcaneus. Bone Joint J. 2018; 100-B (3): p.303-308. doi: 10.1302/0301-620x.100b3.bjj-2017-0715.r2 . | Open in Read by QxMD
  8. Eskridge SL, Hill OT, Clouser MC, Galarneau MR. Association of Specific Lower Extremity Injuries With Delayed Amputation. Mil Med. 2018; 184 (5-6): p.e323-e329. doi: 10.1093/milmed/usy271 . | Open in Read by QxMD

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