Most commonly occurs as a result of a fall from a height the direct axial loading of the calcaneus by the talus – may be associated with spinal fracture. 2% of all fractures and 60% of all rearfoot trauma.
Clinical features:
Pain in heel region, tenderness, swelling, ecchymosis, distortion of anatomy.
Mondor’s sign – bruising from malleoli to sole of foot – common in calcaneus fractures.
Boehler’s angle – normally around 25-40 degrees – if decreased ? fracture
Rowe Classification:
Type 1A Medial tuberosity fracture
Type 1B Sustentaculum tali fracture
Type 1C Anterior process fracture
Type 2A Posterior beak fracture (no achilles involvement)
Type 2B Posterior beak fracture (achilles involvement)
Type 3 Extra-articular fracture of body
Type 4 Intra-articular fracture of body without collapse/depression
Type 5 Intra-articular fracture of body with collapse/depression
Essex-Lopresti Classification (most widely used):
i) Not involving subtalar joint:
a) Tuberosity fracture
1) Beak type
2) Avulsion of medial border
3) Vertical
4) Horizontal
b) Involving calcaneocuboid joint
1) Parrot nose type
2) Various
ii) Involving the subtalar joint
a) Without displacement
b) With displacement
1) Tongue type with displacement
2) Centrolateral depression of joint
3) Sustentaculum tali fracture alone
4) With comminution from below
5) From behind forward with dislocated STJ
Treatment:
Initial management – compression and elevation to reduce swelling;
Compartment syndrome is early complication needs immediate fasciotomy
Long term sequelae:
If compartment syndrome is not recognised early clawing of toes, stiffness, aching, sensory changes
Lack of first rocker sagittal plane block
Limited subtalar joint range of motion
Widening of heel
Osteoarthritis of STJ
Significant varus or valgus alignment.
Lateral impingement syndromes
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