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Calcaneal fractures are the most common tarsal bone fractures, typically resulting from axial loading injuries (e.g., fall from height, motor vehicle accident). They may be intra-articular (involving the subtalar joint – ~70–75%) or extra-articular (not involving subtalar joint).

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These injuries are important due to high rates of disability, malunion, and subtalar arthritis.

Stress Fracture of the Calcaneus - Everything You Need To Know - Dr. Nabil Ebraheim

Epidemiology

• Most common tarsal fracture (~60%).
• Age: young to middle-aged adults.
• Mechanism: high-energy axial trauma.
• Often associated with:
  • Spinal fractures (especially L1) – check spine.
  • Other long bone fractures.

Etiopathogenesis

• Axial load transmitted through talus → calcaneus → compresses posterior facet against talus.
• Leads to collapse, comminution, and widening of calcaneus.
• Extra-articular fractures: avulsion of calcaneal tuberosity or anterior process, often from twisting forces.

Classification

1. Extra-articular fractures (~25–30%)

• Anterior process, sustentaculum tali, body without subtalar extension, calcaneal tuberosity avulsions.

2. Intra-articular fractures (~70–75%)

• Involving posterior facet of subtalar joint.