There is normally a history of a high-energy injury to the foot: a fall or RTA are commonest. Occasionally a fracture may occur with minimal trauma, and stress fractures do occur. The calcaneum can (rarely) be the site of neuropathic fractures.
The foot is extremely swollen and painful. Tenderness and bruising are found around the calcaneum.
Myerson (1993) reports that 9% of patients with os calcis fractures develop compartment syndrome, although this has not been reproduced by other authors. Compartment syndrome occurs primarily in the quadratus plantae muscle (Andermahr et al 2001). Fracture blisters may develop. Nerve and vascular injuries are rare.
It is important not to miss associated injuries. Other significant injuries should be assessed as appropriate, including full ATLS primary and secondary surveys in seriously or multiply injured patients or where there has been a high energy injury. The spine and entire lower limb must be carefully evaluated.