Calcaneal fracture

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At the time the case was submitted for publication Joachim Feger had no recorded disclosures.

Case published: 14 Nov 2019 Revisions: 3 times, by 2 contributors - see full revision history and disclosures Systems: Quiz mode: Full screen case Case with hidden diagnosis Full screen case with hidden diagnosis

Presentation

Persistent heel pain, after a fall down stairs 4 weeks ago.

Patient Data

Age: 45 years Gender: Female From the case: Calcaneal fracture <"current_user":null,"step_through_annotations":true,"access":,"extraPropsURL":"/studies/82666/annotated_viewer_json?_c=1669419896\u0026lang=us">PD mDixon and T1w images show an incomplete, non-displaced, extraarticular fracture of the calcaneal tuberosity extending to the medial surface. Fat-saturated PD mDixon shows mild surrounding bone marrow edema and also a high signal change of the quadratus plantae muscle consistent with edema/hematoma. Syndesmosis, talofibular, calcaneofibular and deltoid ligaments as well as peronael, long flexor and extensor tendons as well as the Achilles tendon are intact.

1 case question available

Q: What are other mechanical causes of heel pain? show answer A: Calcaneal stress reaction or fracture, plantar fasciitis, heel spurs, Achilles tendinopathy, calcaneal apophysitis, Haglund deformity or nerve entrapment, to name a few.

Ankle x-ray

From the case: Calcaneal fracture <"current_user":null,"step_through_annotations":true,"access":,"extraPropsURL":"/studies/82667/annotated_viewer_json?_c=1669419896\u0026lang=us">A follow-up x-ray of the calcaneus 14 days later shows a sclerotic line running through the posterior calcaneal tuberosity.

Case Discussion

This case demonstrates an incomplete, non-displaced, extraarticular fracture of the calcaneal tuberosity. In this case, the patient had a single traumatic event (compression injury after fall downstairs) which caused this incomplete fracture. There was no evidence for long-distance running or other forms of overuse in the patient history since the images would be also typical of a stress fracture. Nondisplaced and noncomminuted calcaneal fractures may be treated conservatively with non-weight bearing for 6-8 weeks and casting or other protective footwear.

References