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. Risk Factors

  1. Beginning runner
  2. Runners on concrete surface
  3. Ballet dancers
  4. Increases in weight bearing on hard surfaces

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
  3. Positive calcaneal Squeeze Test
    1. Pain on squeezing Calcaneus from medial and lateral aspects

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 CT
  4. Foot MRI

IX. Management

  1. Limit weight bearing activity for up to 6 weeks
    1. Consider complete non-weight bearing
    2. Consider CAM Walker boot

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