Calcaneus Stress Fracture


Calcaneus Stress Fracture, Calcaneal Stress Fracture

  • Epidemiology
  1. Second most common foot Stress Fracture (behind Metatarsal Stress Fracture)
  • Pathophysiology
  1. Repetitive heel overload
  2. Most commonly occurs posterior to the posterior facet of subtalar joint
  • Risk Factors
  1. Beginning runner
  2. Runners on concrete surface
  3. Ballet dancers
  4. Increases in weight bearing on hard surfaces
  • Symptoms
  1. Sudden onset of pain at base of foot
  2. Initially pain only with activity ultimately progresses to pain at rest
  • Signs
  1. Localized Ecchymosis and swelling
  2. Point tenderness at the Fracture site
  3. Positive calcaneal Squeeze Test
    1. Pain on squeezing Calcaneus from medial and lateral aspects
  • Differential diagnosis
  1. Acute Calcaneal Fracture with fall from height
  2. Plantar Fasciitis
  • Imaging
  1. Foot XRay
    1. High False Negative Rate
    2. Thin cortex makes Fracture identification difficult
  2. Bone Scan
  3. Foot CT
  4. Foot MRI
  • Management
  1. Limit weight bearing activity for up to 6 weeks
    1. Consider complete non-weight bearing
    2. Consider CAM Walker boot