Diagnosis and Management of Calcaneal Fractures: Current Strategies

Calcaneal fractures represent the most prevalent type of tarsal fractures, comprising up to 75% of all foot fractures. The injuries tend to be related to high-energy trauma. The complex three-dimensional anatomy, multiple classification systems, and condition of the soft tissue envelope make the diagnosis and treatment of these fractures challenging in the affected patient. This chapter provides an updated review of the epidemiology, anatomy, and mechanisms of injury, as well as a detailed discussion of the classification of calcaneal fractures. The various treatment options, including nonoperative treatment, percutaneous treatment, open reduction, and internal fixation via extended lateral, sinus tarsi, and medial approaches, are discussed in detail. The use of subtalar arthroscopy and primary arthrodesis is also reviewed in the context of fracture patterns and patient-specific factors. Postoperative care, with an emphasis on early mobilisation and weight-bearing, is reviewed, with new data supporting an accelerated functional rehabilitation. In conclusion, the successful management of calcaneal fractures depends on an accurate assessment of the patient, meticulous management, and a proper choice of surgical technique, as well as a judicious decision-making process that is tailored to the patient’s specific needs. The future of calcaneal fracture management will require higher-level evidence and the incorporation of emerging new technologies.