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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.
- High-energy axial impact on normal bone (most common) 
- Low-energy axial impact on or diseased bone 
- Heel pain and tenderness
- Swelling and deformity of the foot 
- Plantar ecchymosis ( )
- Fracture blisters
- Other significant coincident injuries 
- X-ray: initial test for all patients with heel pain after trauma
- CT: indicated when 
Initial management 
- Assess for associated injuries and . 
- Provide .
- Apply and/or .
- Obtain orthopedic consultation.
- Admit patients if there is significant edema and/or concern for compartment syndrome.