The calcaneus is one of the tarsal bones of the hindfoot.  It is commonly referred to as the heel bone.  A calcaneus fracture, in simple terms, is a broken heel bone. Calcaneus fractures are often the result of high-energy injuries such as a fall from a height or a motor vehicle accident.  X-rays: • AP, lateral of foot • AP, lateral, oblique of ankle • Harris view (axial heel view) • Consider x-rays of the lumbar spine due to the high incidence of associated vertebral fractures CT scan: If the fracture is intra-articular (involves the joint surface), a CT scan should be obtained. MRI: If no fracture is identified but a stress fracture is suspected, an MRI may confirm this. Classification: • Extra-articular o Anterior process (often missed; “sprain fractures”) o Tuberosity ▪ Open beak ▪ Avulsion at insertion of Achilles tendon o Sustentaculum tali o Body - not involving the subtalar joint o Medial process o Lateral process • Intra-articular body o Tongue type - intra-articular fragment attached to tuberosity fragment o Joint-depression type - intra-articular fragment not attached to tuberosity fragment • Stress fractures

Initial management: • Emergent orthopedic surgery evaluation: o Open fractures o Fracture-dislocations (need reduction) o Compartment syndrome • Urgent orthopedic surgery evaluation: o Intra-articular fractures o Displaced extra-articular fractures • Bulky compression splint (Robert-Jones) • Pack in ice • Elevate • Non-weightbearing • Pain control Definitive treatment: • Anterior process o Nondisplaced or minimally displaced ▪ 1 week compression splint to allow for swelling ▪ Short leg cast 4-6 weeks - neutral position ▪ Physical therapy for range-of-motion, proprioception, strengthening o Displaced or involving > 25% of articular surface with cuboid ▪ Surgery ▪ Closed reduction - percutaneous pinning ▪ Open reduction - internal fixation • Medial or lateral process o Nondisplaced or minimally displaced ▪ 1 week compression splint to allow for swelling ▪ Short leg cast 8-10 weeks - neutral position ▪ Physical therapy for range-of-motion, proprioception, strengthening o Displaced ▪ Closed reduction with well-molded cast • Surgery if unable to obtain good reduction or unstable ▪ Short leg cast 8-10 weeks - neutral position ▪ Physical therapy for range-of-motion, proprioception, strengthening • Tuberosity o Nondisplaced or minimally displaced, uncompromised skin ▪ 1 week compression splint to allow for swelling ▪ Short leg cast 6-8 weeks - 5-10° plantar flexion ▪ Physical therapy for range-of-motion, proprioception, strengthening o Displaced or skin tenting or wounds ▪ Surgery ▪ Suture fragment in place, suture anchors, tension band wiring ▪ Consider screw fixation if large fragment and good quality bone • Sustentaculum tali o Nondisplaced ▪ 1 week compression splint to allow for swelling ▪ Short leg cast 6-8 weeks - 5-10° plantar flexion ▪ Physical therapy for range-of-motion, proprioception, strengthening o Displaced ▪ Surgery ▪ Open reduction - internal fixation • Body o Not involving subtalar joint and < 1 cm displaced ▪ 1 week compression splint to allow for swelling ▪ Short leg cast 10-12 weeks - 5-10° plantar flexion ▪ Physical therapy for range-of-motion, proprioception, strengthening o > 1 cm displaced or involving subtalar joint ▪ Closed reduction - percutaneous pinning ▪ Open reduction - internal fixation • Stress fractures o Mild pain ▪ CAM walker boot, heel inserts ▪ Weight-bearing permitted ▪ Activity restrictions o Severe pain ▪ Non-weightbearing in boot or cast ▪ Gradual return to normal activity over 4-6 weeks