Calcaneal (calcaneus) fractures
Overview
The calcaneus is the largest tarsal bone and the most commonly fractured tarsal bone. Most calcaneal fractures are intra‑articular, involving the posterior facet of the subtalar joint.
They are classically caused by high‑energy axial loading (falls from height, jumps) and carry a high risk of complex articular injury, soft‑tissue compromise and associated injuries-particularly thoracolumbar spine fractures. Early recognition, adequate analgesia, limb protection and timely orthopaedic involvement are essential.
Epidemiology and mechanism
- Typical mechanism: axial load to the plantar surface (fall from height, jump) or crush injuries.
- Most calcaneal fractures are intra‑articular (posterior facet/subtalar joint).
- Extra‑articular fractures include tuberosity, anterior process and sustentaculum tali fractures.
- Associated injuries are common: bilateral calcaneal fractures (~10%), thoracolumbar vertebral fractures (~10%), and ipsilateral foot/ankle fractures (cuboid, talus).
- Low‑energy calcaneal fractures in older adults should prompt fragility assessment and falls prevention per NICE CG146.
Classification and pathophysiology
- Broad categories: intra‑articular (often depressed and comminuted) and extra‑articular.
- Orthopaedics commonly use CT‑based classification systems (e.g., Sanders) for operative planning.
- Soft‑tissue status (swelling, blisters, lateral wall blowout) strongly influences timing of surgery and prognosis.