What is it: Calcaneal stress fractures are microfractures of the heel bone. Acute fractures can also occur after trauma.
How does it present: Stress fractures often present with heel pain that developed after an increase in activity. Pain increases with weight bearing activity. Acute fractures of the calcaneous generally occur after significant trauma to the heel, such as after a fall from a height and landing on the heels.
Common exam findings: The stress fractures may be associated with pain when squeezing the heel. The acute fractures also have tenderness and often times swelling.
Tests and treatment: Foot x-rays can be used to evaluate for either the stress or acute fractures. If a stress fracture is not seen on the foot x-ray, a bone scan or MRI may be needed to further evaluate. If an acute fracture is not seen or needs further evaluation, CT or MRI should be considered. Stress fractures can be treated by limiting weight bearing activities with the use of immobilization and crutches, with gradual return to activities after pain has resolved. Acute fractures should be referred immediately to an orthopedics subspecialist.