Calcaneus Stress Fracture

Aka: Calcaneus Stress Fracture, Calcaneal Stress Fracture

1. See Also
   1. Stress Fracture
   2. Calcaneus Compression Fracture
   3. Calcaneus Anterior Process Fracture
2. Epidemiology
   1. Second most common foot Stress Fracture (behind Metatarsal Stress Fracture)
3. Pathophysiology
   1. Repetitive heel overload
   2. Most commonly occurs posterior to the posterior facet of subtalar joint
4. Risk Factors
   1. Beginning runner
   2. Runners on concrete surface
   3. Ballet dancers
   4. Increases in weight bearing on hard surfaces
5. Symptoms
   1. Sudden onset of pain at base of foot
   2. Initially pain only with activity ultimately progresses to pain at rest
6. 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
7. Differential diagnosis
   1. Acute Calcaneal Fracture with fall from height
   2. Plantar Fasciitis
8. 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
9. Management
   1. Limit weight bearing activity for up to 6 weeks
      1. Consider complete non-weight bearing
      2. Consider CAM Walker boot
10. References
    1. Tu (2018) Am Fam Physician 97(2):86-93 [PubMed]