Journal of Foot and Ankle Surgery
Volume 42, Issue 1 , Pages 43-44, January 2003

Bilateral fractures of the infracalcaneal exostosis☆

Arkansas Foot Clinic, PA, Little Rock, AR.

Article Outline

Abstract 

A case study of bilateral fractures of the inferior calcaneal spur is provided. The patient healed uneventfully after immobilization, cessation of activities, and oral medication. Thirteen months after initial presentation she remains asymptomatic. A brief literature review and discussion of the possible mechanism(s) of injury is included. (The Journal of Foot & Ankle Surgery 42(1):43–44, 2003)

Keywords:  calcaneal fracture, infracalcaneal exostosis, heel spur

 

Numerous articles have discussed the mechanisms 1, 2, 3, 4, classifications 3, 4, 5, 6, 7, diagnostic imaging 6, 8, 9, and treatment 1, 2, 3, 4, 7, 10, 11, 12 of calcaneal fractures. Although several reports discuss the occurrence of fracture of the body of the calcaneus after resection of the inferior heel spur 13, 14, 15, the authors were able to identify only one published article that described a fracture of the infracalcaneal spur itself (16). This article provides a description of an unusual calcaneal fracture involving the inferior exostosis.

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Case study 

A healthy 30-year-old woman presented with complaint of an injury 24 hours prior while swimming at a local pool. She stated that she jumped approximately 1 meter from a bench and landed without shoe gear directly on both heels. The pain was sudden and intense, but resolved within a short period after walking it out. The following morning, she was unable to tolerate any pressure on the heels.

The patient's medical history was unremarkable. Physical examination showed edema over the plantar and medial aspect of the calcaneus bilaterally. This area was acutely painful to palpation, but no other associated areas of tenderness were identified.

Radiographs showed an apparent fracture of the inferior calcaneal spur on both feet (Fig. 1A and B).

A computed tomography scan was ordered to evaluate for possible occult fracture or extension into the body of the calcaneus. No additional fractures were identified.

The patient's postinjury course was uneventful. Treatment consisted of immobilization, protected weight bearing, and nonsteroidal anti-inflammatory medication. Gradual return to activities was instituted at 4 weeks and at 13 months after injury she remains asymptomatic. Serial radiographs show evidence of osseous union at the fracture sites.

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Discussion 

The initial radiographs clearly show a mildly displaced fracture of the inferior calcaneal exostosis. Although the use of a computed tomography scan may be debatable, the rare nature of this injury suggests that a complete evaluation of the rear foot complex is indicated.

The neurovascular status to this patient was not compromised. However, any fracture of the calcaneus may predispose a patient to compartment syndrome in 1 or more of the pedal compartments 17, 18.

In theory, there are 2 mechanisms of action that can result in this type of fracture. The first involves direct impact on the inferior aspect of the calcaneal tuberosity. Alternatively, it is possible that sudden traction placed on the exostosis from originating soft-tissue structures may result in fracture. The plantar fascia and the flexor digitorum brevis would most likely contribute to an avulsion through the windlass effect 19, 20, 21, 22. Our patient's description of the injury and review of subsequent radiographs indicate that direct trauma was the likely mechanism in this case. Both exostoses are displaced superiorly with the inferior separation clearly evident.

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Summary 

The authors have presented an unusual injury that resulted in fracture of the inferior calcaneal spur on both feet. A literature review also has been provided.

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References 

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☆ Address correspondence to: Jesse B. Burks, DPM, MS, FACFAS, Arkansas Foot Clinic, PA, 1417 West Sixth St, Little Rock, AR 72201. e-mail: FTNANKLE@aol.com.

PII: S1067-2516(03)70052-0

Journal of Foot and Ankle Surgery
Volume 42, Issue 1 , Pages 43-44, January 2003

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