Calcaneus fracture12/27/2022 ![]() Distally, the tendon has a concave anterior and convex posterior surface tapering to its broad enthesis on the calcaneus located at the middle third of the posterior surface of the calcaneal tuberosity. It begins at the midcalf level and it receives muscular fibers from three muscles: the medial and lateral heads of the gastrocnemius and the soleus muscles. The Achilles tendon is the strongest tendon in the body and has an average length of 15 cm. Anteriorly, the calcaneus is entirely covered with cartilage forming the surface that articulates with the cuboid.Īchilles Tendon-Posterior Surface of the Calcaneal Tuberosity The fibular (peroneal) trochlea is a bony prominence in the inferior and anterior aspect of the lateral calcaneus that serves to separate the peroneal longus and brevis tendons. At the midbody level, a small prominence marks the attachment of the calcaneofibular ligament. Laterally, the calcaneus has two protuberances. The flexor hallucis longus tendon courses in a groove underneath the sustentaculum tali. Medially, the calcaneus is concave and relatively smooth. Occasionally, the middle and anterior subtalar joints form a contiguous articulation instead of two discrete joints. The smaller oval-shaped anterior facet lies on the superomedial surface of the anterior calcaneus. The middle talar facet is an inclined oval surface on the roof of the sustentaculum. Distal to the posterior subtalar joint is a depression called the calcaneal sulcus that extends medially to terminate at the sustentaculum tali. The posterior talar facet has a triangular shape and a convex contour and is the largest of the three facets. These facets are oriented in slightly different geometric planes and articulate with the inferior aspect of the talus to form the anterior, middle, and posterior subtalar joints. Superiorly, there are three articular facets covered by hyaline cartilage. The anterior part of the calcaneus is tapered distally. It has two smaller inferior tubercles, the medial and lateral processes. The bulbous proximal end is the calcaneal tuberosity, and it serves as the attachment of the Achilles tendon. The calcaneus is a relatively long tarsal bone that has the shape of a pistol grip ( Fig. In this article, we will show the characteristic appearance and location of these fractures, discuss the mechanisms responsible for these injuries, and illustrate potential pitfalls to consider. Of the two types, avulsion fractures generally are more difficult to identify but are quite specific in their locations. Extraarticular fractures are categorized as either compressive or avulsive types. More than 90% of calcaneal fractures are extraarticular in children younger than 7 years, and 60% of such fractures are extraarticular in children 8–14 years old. ![]() ![]() ![]() However, 25% of fractures in adults are extraarticular, and the incidence is even higher in children. Most injuries are caused by high-energy trauma that result in intraarticular fractures. However, radiography remains the principal imaging modality for evaluating trauma to the calcaneus, the most frequently fractured tarsal bone. From a radiographic perspective, the calcaneus is a relatively difficult bone to visualize in its entirety. The morphologic features of this bone are complex, and its many different surface contours function either as attachments to tendons, muscles, and ligaments or as sites of articulations. It is the initial striking surface of the foot during ambulation. The calcaneus is the largest bone in the foot and serves as the primary weight bearing structure in the heel. ![]()
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