The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.
The calcaneus is often compared to a hardboiled egg because it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and become fragmented.
For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences, such as arthritis and chronic pain. Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain.
A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. Fractures involving the joints intra-articular fractures are the most severe calcaneal fractures and include damage to the cartilage the connective tissue between two bones.
The anterior facet is small and the posterior facet is large, inclined anteriorly and located near the middle of the superior surface. Between these two facets runs a fairly deep sulcus, the calcaneal sulcus, which together with the opposing talar sulcus forms the tarsal sinus sinus tarsi.
The tarsal sinus is a large gap between the anterior ends of the talus and calcaneus on its lateral aspect. Superiorly, the calcaneus articulates with the talus at the talocalcaneal joint , also known as the anatomic subtalar joint, making contact at anterior, middle and posterior facets.
The anterior part of the talocalcaneal joint and the talonavicular joint are collectively known as the talocalcaneonavicular joint, and may share the same joint space. Anteriorly, the calcaneus articulates with the cuboid calcaneocuboid joint bones. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form. Check for errors and try again. Thank you for updating your details.
Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free. Edit article. View revision history Report problem with Article. Citation, DOI and article data. Luijkx, T. Reference article, Radiopaedia. Heel bone Calcanea Os calcaneus Calcaneum. The calcaneus provides one point of a solid tripedal surface for the foot.
It also provides a fulcrum for extension and flexion of the foot. The Achilles tendon is the strongest tendon in the body. It is the common tendon for the gastrocnemius calf muscle. Think about how short the calcaneus is as a lever, but how much force it takes for that short lever to lift the entire body weight.
The body is able to do that using just one of the two Achilles tendons. Obviously, direct trauma to the calcaneus will be a cause of pain. However, there are several non-traumatic or repetitive stress injuries that can cause pain in high impact bones like the calcaneus. Heel pain is a common symptom associated with the calcaneus. Calcaneal apophysitis is the most common cause of heel pain in children. A bursa is a fluid-filled sac that acts as a bumper or cushion between potentially tender areas and tissue that can irritate them.
Bursitis that can cause heel or foot pain is an inflammation of the bursae that are commonly found around the insertion points of tendons or between articulated tarsal bones such as the talus and calcaneus talocalcaneal joint. Plantar fasciitis is the most common cause of heel and foot pain in adults. This common tendonitis occurs frequently in runners and can be hard to remedy.
Repetitively striking the heel can lead to the development of stress fractures in the calcaneus. These are often minor cracks that cause pain in the foot. Rarely is a stress fracture very large, but it takes time to heal because it is in the heel. When a tendon rips free of an insertion point, it is known as an avulsion fracture. Usually, the tendon doesn't come apart from the bone, but the bone to which it is attached might break loose, hence the term.
There are two major tendon insertion points on the calcaneus: the Achilles tendon and the plantar fascia tendon. Achilles tendon ruptures are common, but avulsion fractures are not. Calcaneus injury treatment depends on the type and severity of the injury. In general, your healthcare provider may try to use conservative, nonsurgical treatment first.
If that doesn't work, surgery might be necessary to correct an injury. Rehabilitation depends on the severity of the injury and on the choice of treatment. Physical therapy using stretches, massage, and exercises is the most common treatment for plantar fasciitis.
Depending on the healthcare provider, you might be directed to use the RICE method rest, ice, compression, and elevation for treatment or you might be encouraged to use the METH technique movement, elevation, traction, and heat. There's not a clear winner between these two methods. If the plantar fasciitis is severe, your healthcare provider may prescribe a brace and splint to help your plantar fascia heal. In some cases, you will only wear the brace at night while sleeping to assist in stretching the plantar fascia.
If the bone is not displaced due to a fracture, meaning that all the pieces are in the right places, nonsurgical treatment might be appropriate. This is the most common type of treatment for patients with stress fractures of the calcaneus. In the case of severe trauma and complete fractures with displacement, it is often necessary for surgical repair. Once the surgery is done, the patient will still be required to keep pressure off of the heel. Usually, the patient will use braces or splints to hold the heel in the correct position and prevent movement.
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Trabecular bone in the calcaneus of runners. Risser JC. The classic: The iliac apophysis: an invaluable sign in the management of scoliosis. Clin Orthop Relat Res. American Academy of Orthopaedic Surgeons. DeHeer PA. Pediatric Foot Deformities. Philadelphia: Elsevier;
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