The calcaneus is one of the thicker bones in the body. To fracture it takes a lot of force. The main mechanism that causes this fracture is a fall from a significant height, which delivers an axial load that can travel up the body and cause significant associated injuries.
- Vertebral fractures – cervical, thoracic, lumbar. In particular crush fractures of the thoraco-lumbar spine
- Other lower limb fractures: tibia, fibula, femur
- Pelvic and acetabular fractures
- Fracture of the contralateral calcaneum (always check both feet!)
- Compartment syndrome of the foot
- Fracture blisters (blistering of the skin due to oedema/swelling – can lead to soft tissue infection/osteomyelitis)
- Soft tissue injury – ligamentous instability
Conventional X-ray will diagnose most calcaneal fractures, however you must maintain a high index of suspicion in anyone with a suggestive history, who is unable to bear weight on their heel. A “normal” x-ray does not exclude a calcaneal fracture, and CT will often reveal occult fractures.