Fractures of the Calcaneus- An Illustrated Review

Vol 9 | Issue 1 | January-June 2023 | page: 05-17 | Balvinder Rana, Anand Pillai


Authors: Balvinder Rana [1], Anand Pillai [2]

[1] Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.

[2] Department of Trauma and Orthopaedics, Foot & Ankle Division, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.

Address of Correspondence

Dr. Balvinder Rana,

Speciality Doctor, Department of Trauma and Orthopaedics, Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, UK.



Calcaneal fractures are rare injuries accounting for less than 2% of all fractures. There is considerable published literature on calcaneal fractures, but the optimum management has still not been defined clearly because of different fracture patterns, patient characteristics affecting outcome, soft tissue complications associated with surgical treatment and complex anatomy of the calcaneus making accurate surgical reconstruction difficult. New techniques such as minimally invasive surgery (MIS) have shown promise. In this illustrated pictorial review, we summarise the surgical anatomy, pathophysiology, treatment strategies including tips and tricks on surgical management and discuss the current literature for this complex injury.

Keywords: Calcaneus, fracture, calcaneal anatomy, calcaneal fracture management, outcome of calcaneal fracture, classification


1. Mitchell MJ, McKinley JC, Robinson CM. The epidemiology of calcaneal fractures. Foot 2009;19:197–200.

2. Leite CBG, Macedo RS, Saito GH, Sakaki MH, Kojima KE, Fernandes TD. Epidemiological study on calcaneus fractures in a tertiary hospital. Rev Bras Ortop (English Ed 2018;53:472–6.

3. Keener BJ, Sizensky JA. The anatomy of the calcaneus and surrounding structures. Foot Ankle Clin 2005.

4. Luikx T, Elthokapy M, Gregory L, et al. Calcaneus, Reference article,

5. Cahill DR. The anatomy and function of the contents of the human tarsal sinus and canal. Anat Rec 1965;153:1–17.

6. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Jt Surg – Ser A 2000;82:225–50.

7. Essex‐Lopresti P. The mechanism, reduction technique, and results in fractures of the OS calcis. Br J Surg 1952;39:395–419.

8. Lee SM, Huh SW, Chung JW, Kim DW, Kim YJ, Rhee SK. Avulsion fracture of the calcaneal tuberosity: classification and its characteristics. Clin Orthop Surg. 2012 Jun;4(2):134-8. doi: 10.4055/cios.2012.4.2.134. Epub 2012 May 17. PMID: 22662299; PMCID: PMC3360186.

9. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures: Results using a prognostic computed tomography scan classification. Clin. Orthop. Relat. Res., 1993.

10. Cotton FJ, Wilson LT. Fractures of the Os Calcis | NEJM n.d.

11. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicentre trial. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R.JBJS Am. 2002 Oct;84-A(10):1733-44.

12. Tufescu T V, Buckley R. Age, gender, work capability, and worker’s compensation in patients with displaced intraarticular calcaneal fractures. J Orthop Trauma 2001;15:275–9.

13. Paul M, Peter R, Hoffmeyer P. Fractures of the calcaneum. A review of 70 patients. J Bone Jt Surg – Ser B 2004;86:1142–5.

14. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicentre trial. Agren PH, Wretenberg P, Sayed-Noor AS. JBJS Am. 2013 Aug 7;95(15):1351-7

15. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: Randomised controlled trial. BMJ 2014;349:g4483–g4483.

16. Luo X, Li Q, He S, He S. Operative Versus Nonoperative Treatment for Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials. J Foot Ankle Surg 2016;55:821–8.

17. Chen L, Zhang G, Hong J, Lu X, Yuan W. Comparison of Percutaneous Screw Fixation and Calcium Sulfate Cement Grafting Versus Open Treatment of Displaced Intra-Articular Calcaneal Fractures. Foot & Ankle International. 2011;32(10):979-985. doi:10.3113/FAI.2011.0979

18. Stulík, Jiri & Stulik, Jan & Rysavy, Martin & Wozniak, A. (2007). Minimally-invasive treatment of intra-articular fractures of the calcaneum. The Journal of bone and joint surgery. British volume. 88. 1634-41. 10.1302/0301-620X.88B12.17379

19. Magnan B, Bortolazzi R, Marangon A, Marino M, Dall’Oca C, Bartolozzi P. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2006 Nov;88(11) 1474-1479. doi:10.1302/0301-620x.88b11.17759. PMID: 17075093.

20. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin. Orthop. Relat. Res., vol. 468, 2010, p. 983–90.

21. Stulik J, Stehlik J, Rysavy M, Wozniak A. Minimally-invasive treatment of intra-articular fractures of the calcaneum. J Bone Jt Surg – Ser B 2006;88:1634–41.

22. Nosewicz TL, Dingemans SA, Backes M, Luitse JSK, Goslings JC, Schepers T. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures. Foot Ankle Surg. 2019 Oct;25(5):580-588. doi: 10.1016/j.fas.2018.08.006. Epub 2018 Aug 28. PMID: 30321924.

23. Majeed H, Barrie J, Munro W, McBride D. Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: A systematic review of the literature. EFORT Open Rev. 2018 Jul 11;3(7):418-425. doi: 10.1302/2058-5241.3.170043. PMID: 30233817; PMCID: PMC6129959.

24. Heier KA, Infante AF, Walling AK, Sanders RW. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. J Bone Jt Surg – Ser A 2003.

25, Fractures of the Calcaneus 2nd edition, Mandeep S Dhillon, Jaypee publishers, Chapter : Extensile Lateral approach chapter by Richard Buckley and Balvinder Rana

26. Carr JB. Early wound complications of operative treatment of calcaneus fractures: Analysis of 190 fractures. J Orthop Trauma 1999;13:372.

27. Schuberth JM, Cobb MD, Talarico RH. Minimally Invasive Arthroscopic-Assisted Reduction with Percutaneous Fixation in the Management of Intra-Articular Calcaneal Fractures: A Review of 24 Cases. J Foot Ankle Surg 2009;48:315–22.

28. Hoppenfeld S, DeBoer P, Buckley R. Surgical Exposures in Orthopaedics; The Anatomic Approach. Ch. 12, The ankle and foot. Lippincott Williams & Wilkins. 2009

29. Borrelli J Jr, Lashgari C. Vascularity of the lateral calcaneal flap: a cadaveric injection study. J Orthop Trauma. 1999 Feb; 13(2):73-7.

30. Sirisreetreerux N et al. Location of the vertical limb of Extensile Lateral Calcaneal approach and risk of injury of the calcaneal branch of peroneal artery. Foot Ankle Int. 2019 Feb: 40(2); 224-230.

31. John Y. Kwon, MD et. al. Proximity of the Lateral Calcaneal Artery With a Modified Extensile Lateral Approach Compared to Standard Extensile Approach. Foot & Ankle Int.2016; 38 (3):318-323.

32. Pitts CC, Almaguer A, Wilson JT, Quade JH, Johnson MD. Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi. Foot Ankle Int. 2019 Aug;40(8):929-935. doi: 10.1177/1071100719848063. Epub 2019 May 14. PMID: 31088171.

How to Cite this article: Rana B, Pillai A | Fractures of the Calcaneus- An Illustrated Review | January-June 2023; 9(1): 05-17 |


(Abstract Text HTML)   (Download PDF)