Calcaneous Stress Fracture

 Calcaneous superior view


Calcaneal Stress Fracture ICD-10

Calcaneal Stress Fracture ICD-9

  • 733.95(stess fx of other bone), 825.0(calcaneous fracture closed)

Calcaneal Stress Fracture Etiology / Epidemiology / Natural History

  • Risk factors=running, female sex. 

Calcaneal Stress Fracture Anatomy

  • Transmits body weight to ground, strong lever arm for calf muscles
  • Main weight beaing surface is the posterior facet
  • Peripheral structures of the calcaneus include the sustentaculum tali, the peroneal tubercle, and the medial and lateral calcaneal tubercles.
  • Anterior process: a saddle-shaped projection of bone at the superior aspect of the calcaneal body. Its inferior surface articulates with the cuboid. The bifurcate ligament inserts on the anterior process and connects the cuboid and navicular bones. Serves as the origin of part of the extensor digitorum brevis.
  • Tibial nerve crossses the calcaneous below the sustentaculum tali medially and may be injured with displaced fractures causing incomplete loss of sensation on the plantar surface of the foot.

Calcaneal Stress Fracture Clinical Evaluation

  • diffuse heel pain and swelling

Calcaneal Stress Fracture Xray / Diagnositc Tests

  • Plain films are initially negative. Approximately 10 days after symptoms start x-rays reveal a line or density in the posterosuperior portion of the calcaneus perpendicular to the trabecular stress lines.
  • MRI: best test, highly sensitive. (Sormala MJ, JBJS 2006;88A:2237).

Calcaneal Stress Fracture Classification / Treatment

  • rest, activity modifications

Calcaneal Stress Fracture Associated Injuries / Differential Diagnosis

  • Talar stress fracture
  • Navicular stress fracture
  • Cuboid stress fracture

Calcaneal Stress Fracture Complications

Calcaneal Stress Fracture Follow-up Care

Calcaneal Stress Fracture Review References

  1. Boden BP: Low risk stress fractures. Am J Sports Med 2001;29:100-111.
  2. Leabhart JW: Stress fracture of the calcaneus. JBJS Am 1959;41:1285-1290.