Calcaneal fractures account for about 2% of all fractures and 60% of major tarsal injuries. They occur most commonly in middle adult life although have been reported at both extremes of age. They are serious injuries which often affect manual workers and may prevent them returning to work.
Most are closed injuries; published series of open fractures (Furey et al 2003, Heier et al 2003, Lawrence et al 2003) come from large trauma units in which open fractures, often with polytrauma, made up 10-15% of all calcaneal fractures, but in most units the proportion will be lower.
There is an association with lumbar spine (10-30%), pelvis, hip, tibia and ankle fractures.
CT scanning has greatly improved understanding of the anatomy of these complex fractures.
Opinion has swung between non-operative treatment and surgical reconstruction. Recent large RCTs suggest that surgery is less effective than was thought over the last 20 years, and a more selective policy currently seems in order. Recent work on minimally-invasive fixation is promising but has yet to be examined in prospective, comparative trials.
A recent systematic review (Gougoulias 2009) gives a valuable overview of the evidence although is occasionally inclined to give too much of the benefit of the doubt to surgical treatment in our view.