Calcaneus Fatigue Fractures


- Discussion:
    - frx results from multiple compressive loads in wt-bearing activities;
    - most often seen in military recruits;
    - symptoms include pain and swelling on both sides of heel and exquisite tenderness to palpation on the lateral & medial aspects of the heel;
    - diff dx of heel pain: (main consideration is plantar fascititis):


- Radiographs:
    - may not become positive for 2-4 weeks (or as healing stage occurs);
    - on lateral radiograph, look for subtle area of increased density which is perpendicular to trabecular stress lines;
          - usually, the density is oriented vertically thru posterior aspect of calcaneus, from posterior-superior surface to the anterior-inferior surface;
    - trabecular pattern is perpendicular to the frx line;

- Bone Scans:
    - may be useful w/ acute symptoms and negative radiographs;
    - often 2-8 days must pass before bone scans become positive;



- Treatment:
    - reduction of activity, cast or brace immobilization until symptoms resolve and bone-healing is evident on radiographs;
    - physician should allow 4-8 weeks prior to resumption of activity



Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus.  

Stress Injuries of the Calcaneus Detected with Magnetic Resonance Imaging in Military Recruits.

Insufficiency Fracture of the Calcaneus. Similar to March Fracture of the Matatarsal.

Distribution and natural history of stress fractures in U.S. Marine recruits.

Stress Fractures of the Calcaneus.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 22, 2012 2:10 pm