35-Year-Old With Heel Pain After a Fall

Differential Diagnosis

• Calcaneal spur
• Achilles tendon rupture
• Comminuted impacted posterior calcaneus fracture
• Heel bone contusion

Diagnosis

The patient was diagnosed with comminuted impacted posterior calcaneus fracture. The axial view image reveals a comminuted irregular cortical overlap of the posterior calcaneus, and the lateral view image reveals an oblique band of sclerosis of the posterior calcaneus.

What to Look For

• The mechanism of injury is most often heavy axial loading such as a big jump or fall
• Pain is usually severe, and patients are unable to bear weight on the heel
• The heel usually has tenderness to palpation, erythema, and swelling

Pearls for Urgent Care Management

• Initial management is with rest, ice, elevation, and pain management
• Extraarticular fractures generally heal well with conservative treatment
• Intraarticular fractures require surgical referral (podiatry or orthopedics)
• As this is the result of trauma, keep in mind other possible concomitant injuries

Acknowledgement: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).

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Read More

• Managing Foot Fractures In Urgent Care
• Managing Foot Fractures In Urgent Care Part 2
• Top 5 Common Causes—And Controversial Conducts—Of Heel Pain In Urgent Care