II. Epidemiology

  1. Second most common foot Stress Fracture (behind Metatarsal Stress Fracture)

III. Pathophysiology

  1. Repetitive heel overload
  2. Most commonly occurs posterior to the posterior facet of subtalar joint

IV. Risks

  1. Beginning runner
  2. Runners on concrete surface
  3. Ballet dancers

V. Symptoms

  1. Sudden onset of pain at base of foot
  2. Initially pain only with activity ultimately progresses to pain at rest

VI. Signs

  1. Localized Ecchymosis and swelling
  2. Point tenderness at the Fracture site

VII. Differential diagnosis

  1. Acute Calcaneal Fracture with fall from height
  2. Plantar Fasciitis

VIII. Imaging

  1. Foot XRay
    1. High False Negative Rate
    2. Thin cortex makes Fracture identification difficult
  2. Bone Scan
  3. Foot MRI

IX. Management

  1. Decreased weight bearing activity
  2. Consider CAM Walker boot
  3. Consider non-weight bearing

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