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