Calcaneal fractures

NewsBot · Oct 19, 2024

A Scoping Review: How should fractures of the Anterior Process of the Calcaneus be managed in athletes?
Joseph Franklin, Charles Offer
doi: https://doi.org/10.1101/2024.10.18.24315738

Lay Summary The Anterior Process of the Calcaneus is part of the heel bone (calcaneus), located near to where this bone meets the Navicular bone. Both bones are in the foot. The main mechanism that causes this injury, in the sporting context, is an avulsion injury. Essentially, a ligament, that attaches the calcaneus to the navicular, is pulled with such force that it pulls off some of the attached calcaneus bone. Commonly this occurs when athletes roll their ankles. Historically, these fractures have often been misdiagnosed, with fractures being mistaken for bad sprains and soft tissue damage. This misdiagnosis has led to the mismanagement of these injuries with poor patient outcomes and recovery. Despite growing amounts of guidance available, there is still a lack of clarity in the literature. This is particularly the case in how this injury should be managed in the athlete looking to return to sport. This review seeks to analyse the preexisting guidance in the management of these injuries, pulling resources together, to better direct the clinician and improve patient/athlete outcomes. This review will also highlight areas where more research is needed.
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NewsBot · Oct 26, 2024

Short term efficacy of subtalar arthroscopy combined with medial calcaneal-talar joint distraction in minimally invasive treatment of diabetic patients with calcaneal fractures: a retrospective study
Xiaoyu Dai et al
BMC Musculoskelet Disord. 2024 Oct 25;25(1):849. doi: 10.1186/s12891-024-07960-7.

Background: The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device.

Methods: The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45-72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy.

Results: 52 patients were followed up for 23.7 ± 3.2 months (range: 20-28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05).

Conclusions: Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients.
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NewsBot · Oct 29, 2024

Effectiveness of accelerated rehabilitation surgical nursing on perioperative outcomes in patients with calcaneal fractures
Qian Xie 1, Bin Zhao, Zhenhua Fang
Medicine (Baltimore). 2024 Oct 11;103(41):e39409

This study aims to evaluate the impact of accelerated rehabilitation nursing on perioperative outcomes in patients with calcaneal fractures. A total of 101 patients with calcaneal fractures admitted from December 2020 to December 2022 were included in this study. Patients were randomly assigned to an observation group (OG) of 51 patients receiving accelerated rehabilitation surgical nursing and a control group (CG) of 50 patients receiving conventional surgical nursing. Outcomes assessed included patient satisfaction, visual analog scale (VAS) scores before and after surgery, swelling reduction time, and complication rates. The satisfaction rate in the OG was 96.07%, significantly higher than the 80.00% observed in the CG. Post-operative VAS scores at day 4 and 6 were significantly lower in the OG compared to the CG. Swelling reduction time was shorter in the OG (152.56 ± 25.22 hours) compared to the CG (170.76 ± 22.51 hours). Additionally, the complication rate in the OG was significantly lower at 7.84% compared to 24.00% in the CG (P < .05).the implementation of accelerated rehabilitation nursing significantly shortened the average length of hospital stay for patients in the observation group. In contrast, patients in the control group, who received conventional nursing care, had a relatively longer hospital stay. In the perioperative treatment of calcaneal fractures, accelerated rehabilitation surgical nursing can significantly improve patient satisfaction, reduce pain, shorten the time for swelling to subside, and lower the incidence of complications. Additionally, it can shorten the hospital stay for patients, demonstrating its efficacy and potential for broader clinical application.
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NewsBot · Nov 13, 2024

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot and Ankle Surgery; 13 November 2024

Background
Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.
Methods
The study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis.
Results
The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.
Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures.
Conclusion
Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Nov 15, 2024

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot and Ankle Surgery; 13 November 2024

Abstract
Background
Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.
Methods
The study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis.
Results
The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.
Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures.
Conclusion
Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Nov 19, 2024

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial
Coen Verstappen et al
Trials. 2024 Nov 18;25(1):778.

Background: Following successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications.

Methods: Study design: A prospective multicenter randomized controlled trial.

Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18-67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included.

Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB.

Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)).

Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks.

Discussion: This study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic.
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NewsBot · Nov 26, 2024

Calcaneus fractures, epidemiology and treatment - Data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot Ankle Surg. 2024 Nov 13:S1268-7731(24)00237-6

Background: Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.

Methods: The study is based on data from the Swedish Fracture Register and include patients ≥ 18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n = 320, could be identified and were studied in a separate analysis.

Results: The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60 %) were men. Fall from height was the most common mechanism of injury (n = 1683; 46 %) and high-energy trauma was documented in 887(28 %) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n = 1105; 89 %) and B (n = 717; 93 %) fractures were treated non-surgically, while surgical treatment was more common in type C (n = 499; 43 %) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used. Of the patients with bilateral fractures 80 % were male, (n = 128). They were generally younger (mean age of 38 years (SD±14.5, p < 0001) and had a larger proportion of high-energy traumas, n = 107 (67 %) compared with patients with unilateral fractures.

Conclusion: Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Dec 3, 2024

Mid-term results of intra-articular calcaneal fractures treated with minimally invasive two-point distractor : Single center study with 6-year follow-up
Matthias Stark et al
Wien Klin Wochenschr. 2024 Dec 2

Background: Displaced intra-articular calcaneal fractures are a complication-ridden injury to treat and there are various treatment techniques to address this injury. The aim of this study was to evaluate the mid-term outcome of a percutaneous two-point distractor technique in patients with displaced intra-articular calcaneal fractures.

Methods: A retrospective data analysis of patients with intra-articular calcaneal fractures treated in a level 1 trauma center was conducted. The patients were subsequently invited for a follow-up visit to assess the mid-term outcome. The Böhler's and Gissane's angles, the American Orthopaedic Foot & Ankle Society hindfoot score, the Maryland foot score and a visual analog scale for pain were measured preoperatively and postoperatively and after at least 6 years to assess the radiological and functional outcome.

Results: Of the patients 59 completed the study with a mean follow-up of 76 months after surgery. The mean American Orthopedic Foot and Ankle Society hindfoot score at the last follow-up visit was 81, the mean Maryland foot score was 78. There were three cases (5%) of superficial wound complications and secondary arthrodesis of the subtalar joint was performed in five patients (8%).

Conclusion: The low rates of postoperative infections and secondary arthrodesis in this study underline the good to excellent mid-term functional results for a minimally invasive technique.
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NewsBot · Dec 4, 2024

Gait assessment in patients with intra-articular calcaneal fractures after treatment with the Ilizarov method
Marcin Pelc et al
Injury. 2024 Nov 27;56(2):112070

Background: Intra-articular and comminuted fractures of the calcaneus constitute a significant orthopedic challenge. Calcaneal fracture management should primarily aim to achieve good clinical and biomechanical outcomes, pain reduction, and normal function following treatment.

Research question: How does Ilizarov treatment of calcaneal fractures affect gait parameters?

Methods: This retrospective study included 21patients (7 women, 14 men) who were treated for intra-articular calcaneal fractures with the Ilizarov method in the period 2021-2022. Nineteen healthy volunteers constituted the control group. Gait assessments were conducted with a BTS G-SENSOR device (BTS Bioengineering Corp., Quincy, MA, USA). The gait assessment evaluated the following parameters: assessment duration expressed in seconds (s), cadence expressed as the number of steps per minute (steps/min), gait velocity (m/s), stride length (m), stance phase (%), swing phase (%), double support phase (%), and single support phase (%).The study assessed pain intensity in the VAS scale, Böhler's angle and Gissane's angle.

Results and significance: We observed no significant differences between the experimental group and the healthy control group in terms of cadence, gait velocity, or stride length. Patients in experimental group showed significantly shortened stance and single support phases in the treated limb in comparison with those in the intact limb; the remaining gait parameters were similar in the treated and intact limb. We observed no significant differences between the treated limbs in the patient group and the nondominant limbs in the control group in terms of any gait parameters. In the follow-up, the average pain value on the VAS scale was 2.3. The median Böhler angle changed from 5.5° preoperatively to 28.5° postoperatively, p < 0.001. The median Gissane's angle was 119° before surgery and 143° after surgery, p < 0.001.The use of the Ilizarov method in the treatment of calcaneal fractures helps achieve sufficient normalization of most gait parameters, with their values similar to those observed in healthy volunteers. After treatment of calcaneal fractures using the Ilizarov method, radiological parameters improved. The biomechanical outcomes of calcaneal fracture treatment with the Ilizarov method are good.
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NewsBot · Dec 23, 2024

Analysis of Calcaneal Avulsion Fractures Treated Surgically and Nonsurgically
A Retrospective Multicenter Study
Yu Takahashi et al
JB JS Open Access. 2024 Jul 10;9(3):e23.00127

Background:
Calcaneal avulsion fractures (CAvFs) at the Achilles tendon insertion are among the more challenging fractures to treat. Although rare, they often require reoperation. The optimal treatment, including nonsurgical procedures and better implants for surgical procedures in the treatment of CAvFs, remains to be established. Therefore, our study aimed to (1) perform a descriptive evaluation of CAvFs, including cases managed nonsurgically, and (2) assess surgical procedures, including the incidence of complications and reoperation for surgically treated CAvFs.

Methods:
In this multicenter retrospective study, we collected data of patients with CAvFs treated at 9 hospitals from 2012 to 2022. We performed a descriptive study of CAvFs and compared postoperative complications and reoperation rates for multiple surgical techniques and implants. The size of the bone fragments was quantified.

Results:
The data of 70 patients with CAvFs were analyzed; 20 patients were treated nonsurgically, and 50 were treated surgically. The mean age of patients was 68.5 years; 67% of the patients were female. Nineteen percent of the patients had diabetes, and 19% had osteoporosis. The incidence of postoperative complications was 30%, with infection in 14%, necrosis in 26%, and loss of reduction in 18%. The reoperation rate was 22%. Surgical techniques with use of cannulated cancellous screws were performed in 80% of the surgical cases. Cannulated cancellous screw (CCS) fixation alone resulted in a reoperation rate of 35%, whereas additional augmentation, including washers with CCS fixation, resulted in a reoperation rate of 10%. CCS fixation was successfully performed, although suture anchors were used in some cases with smaller fragments.

Conclusions:
CAvFs occurred more frequently in older women and had a high rate of postoperative complications. A combination of CCS with augmentation was more effective at reducing postoperative complications than CCS fixation alone, even when the bone fragment size was small.
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NewsBot · Jan 25, 2025

Three-Plane Calcaneal Osteotomy With Joint Preservation vs Subtalar Arthrodesis to Treat Painful Calcaneal Fracture Malunions
Hui Feng et al
Foot Ankle Int. 2025 Jan 24:10711007241310228.

Background: Calcaneal fracture malunion (CFM) commonly occurs with multiple pathologic changes and progressive pain and difficulty walking. The purpose of this study was to propose a modified 3-plane joint-preserving osteotomy for the treatment of CFM with subtalar joint incongruence, and to compare its efficacy to subtalar arthrodesis.

Methods: A retrospective comparative analysis of the data of 56 patients with CFM admitted from January 2017 to December 2022 was performed. Twenty-six patients were in the osteotomy group and 30 in the arthrodesis group. Computed tomographic (CT) scans were used for measurement of the intraarticular steps. Radiologic parameters, visual analog scale (VAS) score for pain, 12-Item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scores were compared between the 2 groups of patients to assess the outcome preoperatively and at last follow-up, which averaged 22.6 ± 3.6 months and 27.6 ± 3.6 months for the osteotomy and arthrodesis groups, respectively.

Results: Improvements in pain, function, and overall quality of life were obtained in both groups compared with the preoperative values at last follow-up. The VAS and SF-12 scores were similar between the groups at the last follow-up. In the osteotomy group, the average CT scan-measured intraarticular step-offs were significantly reduced from 3.7 ± 1.2 mm to 0.9 ± 0.3 mm. The osteotomy group showed improvement in pronation and supination range of motion (ROM) of the feet (P < .01). The correction of the ankle height and Meary angle were slightly better in the osteotomy group.

Conclusion: In this short-term follow-up study, good results were achieved in both joint-preserving osteotomy and subtalar arthrodesis groups for the treatment of CFM with subtalar joint incongruence. The osteotomy group preserved the subtalar joint and achieved improvements in pronation and supination ROM.
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NewsBot · Apr 24, 2025

Up and down - The impact of calcaneal fracture on medial gastrocnemius fascicle behavior and ankle biomechanics during heel-rise performance
Andreas Brand et al
Gait Posture. 2025 Apr 15:120:199-204.

Background: Calcaneal fractures (CF) often result in reduced foot mobility and plantar flexor strength, despite intensive rehabilitation. While treatment mostly focuses on bone restoration, structural and functional adaptation of the ankle plantar flexors during movement is less understood.

Research question: To investigate medial gastrocnemius fascicle behavior and ankle biomechanics in patients with CF during bipedal heel-rise.

Methods: Repetitive heel-rise was analyzed in 18 patients with unilateral CF (BMI: 27.3 ± 3.2 kgm-2, Age: 50 ± 13 years) and 18 healthy controls (BMI: 26.3 ± 3 kgm-2, Age: 48 ± 11 years) using motion capture and ultrasound. Patients were measured 3 and 12 months after surgery. Dynamic gastrocnemius fascicle length, pennation angle, thickness, ankle angle, ground reaction force, heel lift, and Böhler angle were assessed.

Results: Between 3 and 12 months, pennation angle in patients increased by up to 33 % (p < 0.05), while fascicle length and thickness remained unchanged. Ankle plantarflexion and heel lift showed no improvement, while ground reaction force and symmetry increased by 12 % and 55 %, respectively. Compared to controls, patient's fascicle parameters showed no differences, while a reduced maximum plantarflexion and heel lift by up to 41 % remained. Ground reaction force recovered to control levels at 12 months. The average Böhler angle was 21.6° (9.8-41.6°).

Significance: Impaired foot stability and alignment originating from altered calcaneal anatomy after fracture, rather than muscle deficits, primarily contribute to a reduced ankle joint function one year post-surgery.
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NewsBot · May 29, 2025

Displaced, intra-articular fractures of the calcaneus: Review of non-operative management, open reduction internal fixation and novel minimally invasive techniques
Adrian J Talia et al
Foot (Edinb). 2025 Mar:62:102160. doi: 10.1016/j.foot.2025.102160.

Calcaneal fractures comprise 1-2 % of all fractures and typically occur in younger, working age male patients. These injuries result in a significant burden to the patient in terms of residual pain, inability to work or participate in sports, difficulty with shoe wear and secondary reconstructive surgery such as subtalar arthrodesis. They also result in a significant burden to the healthcare system. Calcaneal fractures can be sub-classified into extra-articular and intra-articular, two-thirds of calcaneal fractures involve the articular facets of the subtalar joint. The treatment of displaced intra-articular calcaneal fractures is controversial, with many authors recommending non-operative treatment. The concerns with this approach include painful malunion, articular surface disruption, heel varus and increased calcaneal width, with a significant rate of secondary reconstructive surgery. Traditional operative approaches for calcaneal fractures allowed the surgeon to restore anatomic parameters, but have been associated with high rates of soft tissue complications, up to 40 % in some series. Newer, less invasive techniques for fixation allow the surgeon to obtain a similar anatomic reduction with reduced tissue compromise. We performed a systematic literature search which identifed forty articles on which this review is based. In this review article we discuss the background of displaced, intra-articular calcaneal fractures and compare the current knowledge base of operative vs. non-operative management. We then compare and contrast the three common surgical approaches used for treatment of these injuries: the extensile lateral approach, the sinus tarsi approach and newer percutaneous/minimally invasive techniques. At the current time, the sinus tarsi approach is the mainstay for treating these fractures, with most authors favouring this over the extensile lateral approach. There is momentum for adoption of newer minimally invasive techniques which show promising results, with reduced soft tissue complications and satisfactory functional outcomes.
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NewsBot · Jul 4, 2025

The role of early weight bearing in the aftertreatment of unilateral displaced intraarticular calcaneal fractures: a systematic review and pooled analysis
Coen Verstappen et al
J Orthop Traumatol. 2025 Jul 3;26(1):43.

Background: Displaced intraarticular calcaneal fractures (DIACFs) remain a complex challenge in orthopedic practice due to their complexity and the intricate nature of surgical interventions. While surgical techniques have evolved, postoperative rehabilitation is equally crucial for achieving optimal outcomes. This systematic review evaluates the effects of early weight bearing (EWB) in surgically treated patients with unilateral DIACFs on patient-reported outcomes, health-related quality of life, postoperative pain, differences in Böhler's angle, and complication rates.

Methods: A systematic literature search was performed across PubMed, Embase, and Cochrane Library up to January 2025. Eligible studied included adults (≥ 18 years) who underwent surgery for unilateral DIACFs (Sanders type II-IV), implemented an EWB protocol, reported at least one patient-reported outcome, and were published from 2000 onward. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale.

Results: From 1007 identified records, 20 studies (n = 1051 DIACFs) met the inclusion criteria. Pooled results showed a mean American Orthopedic Foot and Ankle Society (AOFAS) Score of 85.7, Maryland Foot Score of 91.1, and visual analog score of 1.9. The analysis revealed a decline of 0.4 degrees in Böhler's angle from postoperative to last follow-up. The overall complication rate was 13.9%.

Conclusions: EWB protocols appear to be safe and beneficial in the postoperative management of DIACFs, yielding favorable outcomes without increased complication rates. These findings support the reconsideration of current conservative weight-bearing guidelines. Future research should focus on the development of standardized, evidence-based after-treatment guidelines.
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NewsBot · Jul 6, 2025

Clinical comparison of modified sinus tarsi approach and L-shaped approach in open reduction and internal fixation for Sanders typeIII-IV intra-articular calcaneal fractures: Complications, security, effectiveness analysis
Yang Bin et al
J Orthop Sci. 2025 Feb 26:S0949-2658(25)00042-9.

Background: L-shaped incision is the most widely used approach for treating calcaneal fracture; however, it has been associated with various complications, such as wound infection, skin edge necrosis, postoperative fracture malunion, and traumatic arthritis. Accordingly, this surgical approach should be re-examined. This study aimed to investigate the clinical effect and safety of the modified sinus tarsi approach in open reduction and internal fixation for Sanders type III-IV calcaneal fractures and compare it with the traditional L-shaped approach.

Methods: This retrospective study enrolled 72 patients with unilateral closed Sanders type III-IV calcaneal fractures treated with a modified sinus tarsi approach (38 patients) and L-shaped approach (34 patients) from May 2018 to June 2020. Postoperative complications and changes in calcaneal Böhler angle, Gissane angle, and Varus angle were observed and compared between the two groups before and 3 days, and 12 months after the operation. At 12 months after the operation, the Maryland foot function score, AOFAS score, and VAS score were used to evaluate the recovery of foot function in both groups.

Results: The modified tarsal sinus approach group had significantly shorter incision healing time (9.8 ± 1.9 d) and operation time (75.53 ± 21.12 min), as well as fewer wound-healing complications (2.6 %) compared to the L-shaped approach group (P < 0.05). There were no significant differences in the Böhler, Gissane, and Varus angles between the two groups after the operation. At 12 months after the operation, no significant differences were observed in Maryland, AOFAS, and VAS scores.

Conclusion: The modified sinus tarsi and L-shaped approaches had similar clinical effects in the treatment of Sanders type III-IV calcaneal fractures. However, the treatment of modified sinus tarsi approaches in open reduction and internal fixation for Sanders type III-IV calcaneal fractures implies small incision, low degree of soft tissue injury, and low wound-healing complications, thus resulting in an effective minimally invasive treatment for Sanders type III-IV calcaneal fractures.
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NewsBot · Aug 14, 2025

Analysis of Calcaneal Fracture-Related Complications-A Retrospective Chart Review
Géraldine Désirée Sturz-Jantsch et al
J Clin Med. 2025 Aug 6;14(15):5535.

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes.
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NewsBot · Aug 22, 2025

Epidemiology of Calcaneal Fractures in a Level One Trauma Center in the United Arab Emirates: A Retrospective Study
Abdulla Abdelwahab et al
Saudi J Med Med Sci. 2025 Jul-Sep;13(3):218-221.

Background: Calcaneal fractures are one of the most common fractures affecting the tarsal bone; however, their epidemiology and management in the United Arab Emirates (UAE) is not well studied.

Objective: To evaluate the epidemiology, injury patterns, and treatment approaches for calcaneal fractures in the UAE.

Methods: This retrospective study included adult patients (≥18 years) who were diagnosed with calcaneal fractures at Rashid Hospital, Dubai, UAE, over a 6-year period. Demographics, injury characteristics, fracture type, treatment, and associated injuries were all assessed.

Results: A total of 1082 patients with calcaneal fracture cases were included, with males comprising 87.3% (male-to-female ratio: 6.9:1). Most patients were aged 20-39 years (69.5%). The most common cause of the fracture was falls (68.6%), mostly from ≤3 meters (48.9%). Surgery was performed in 28.4% of cases, most often for closed displaced fractures (45.7%). Lower limb (48%) and spine (8.5%) were the most common associated injuries.

Conclusions: Calcaneal fractures in the UAE are predominantly seen in young males, usually resulting from falls, most commonly leading to closed displaced fractures, and commonly associated with significant comorbid injuries. The results support the necessity of providing the target populations with preventive measures and identifying the efficient management approaches to reduce the morbidity level.
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NewsBot · Oct 1, 2025

Measurement of the sustentaculum tali range and biomechanical screw analysis based on the space shape of the calcaneal trabeculae
Yong Zhang et al
BMC Musculoskelet Disord. 2025 Sep 30;26(1):873.

Background: The sustentaculum tali (ST) plays an important role in the surgical treatment of calcaneal fracture. However, there is a lack of relevant literature report on the true extent of the distance process. The introduction of the 'space shape of the trabeculae within the calcaneus allowed the ST range to be defined with reference to the trabecula topographic trend. Here, we investigated the biomechanical properties of two common ST screws after implantation by applying the finite element method (FEM).

Methods: Dicom imaging data of the calcaneus ST was obtained by computed tomography (CT)scanning techniques and a spatial three-dimensional (3D) coordinate system was established to measure the extent of the ST. The continuation range was identified according to the trend of the trabecula bone and then superimposed to form a new ST range. Next, by structural design and FEM, we performed biomechanical tests on the two type of ST screws: the 'pressure type (transverse group)' test for vertical fracture lines and the 'tension type (oblique group) of the center' test.

Results: Based on space shape of the trabeculae within the calcaneus, the spatial extent of the ST was redefined. According to FEM calculations, the load bearing capacity of the transverse group was better than that of the oblique group by 15.15% when the screws were implanted in the peak area. Furthermore, the load bearing capacity of the oblique group was better than that of the transverse group by 14.13% and 5.59% when the screws were implanted in the lumbar and valley regions.

Conclusions: Based on the space shape of the trabeculae within the calcaneus, the range of the ST is expanded. The best mechanical properties of two different screws were implanted in the peak area. The load-bearing capacity gradually reduced when implanted in the lumbar and valley regions. However, the waist area and valley area can still meet the requirements for structural strength and stability, and also provide a good fixation effect.
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NewsBot · Oct 28, 2025

Biomechanical Assessment in Calcaneal Fracture Management: Methods, Clinical Applications, and Future Directions
Guangsheng Tang et al
Ann Ital Chir. 2025 Oct 10;96(10):1290-1298

This review explores the biomechanical evaluation of calcaneal fractures, utilizing techniques such as computed tomography (CT) imaging and finite element analysis to assess fracture stability, alignment, and load distribution. These evaluations are essential for enhancing treatment approaches and improving patient outcomes. The review underscores the significance of quantitative metrics in linking biomechanical parameters with clinical outcomes, thereby facilitating personalized treatment planning. Future research advancements are anticipated to focus on integrating high-throughput biomechanical approaches, multimodal datasets, and artificial intelligence to enhance the precision of fracture evaluations and develop tailored interventions that foster better recovery and overall quality of life for patients with calcaneal fractures.
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NewsBot · Dec 14, 2025

Calcaneal fracture outcome score (CFOS): A novel outcome-based prognostic CT grading for calcaneal fracture reduction
Jan Siad El Barbari et al
Injury. 2025 Dec 4;57(2):112947.

Introduction: While radiographic reduction quality is considered a key determinant of outcome in intraarticular calcaneal fractures, its quantification remains inconsistent and often unidimensional. Existing radiographic parameters only partially reflect the complex joint surface restoration while gradings often lack correlation to clinical outcomes. This study introduces the Calcaneal Fracture Outcome Score (CFOS), a composite score integrating joint-specific deformities and patient-level prognosticators to improve outcome prediction.

Material and methods: Postoperative CT scans from 80 patients with surgically treated calcaneal fractures were evaluated for residual step, gap, and angulation at the posterior facet (PF) and calcaneocuboid (CC) joint. Additional parameters included Boehler's angle, Gissane's angle, Sanders classification, smoking status, and comorbidity burden. All variables were z-standardized and entered into a LASSO regression with 5-fold cross-validation. A weighted score (CFOS) was computed per patient and correlated with PROMS (VAS-FA; SF-12).

Results: Higher CFOS grades were associated with significantly worse outcomes, i.e. posttraumatic osteoarthritis (p<0.001), VAS-FA (p=0.035) and SF-12 PCS (p=0.010), outperforming the traditional grading established by Kurozumi et al and adapted by Nosewicz et al. with a mean positive predictive value of 90 %.

Conclusions: The CFOS offers a clinically intuitive, multidimensional assessment of reduction quality and provides robust predictive value for postoperative functional outcome.
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Calcaneal fractures

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Psychological dysfunction following calcaneal fractures

Calcaneal stress fractures in minimalist/barefoot runners

Inaccuracies in the public advertising about calcaneal apophysitis

Calcaneal spur and its correlation with the talar articular facets

Calcaneal morphology and plantar fasciitis

Calcaneal spur and vitamin D, lipid profile and calcitonin

Painful Calcaneal Spur Often Misdiagnosed for Lumbar Radicular Pain

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Calcaneal fractures

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Psychological dysfunction following calcaneal fractures

Calcaneal stress fractures in minimalist/barefoot runners

Inaccuracies in the public advertising about calcaneal apophysitis

Calcaneal spur and its correlation with the talar articular facets

Calcaneal morphology and plantar fasciitis

Calcaneal spur and vitamin D, lipid profile and calcitonin

Painful Calcaneal Spur Often Misdiagnosed for Lumbar Radicular Pain

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