Calcaneus fracture

The calcaneus is your heel bone — the largest bone in your foot. A calcaneus fracture happens when that bone breaks under heavy axial force, almost always from a fall that lands hard on the heel. About 1 in 10 of these fractures occur on both heels at once (the same fall hits both sides), and that pattern raises the chance of a low-back fracture too — your surgeon will check your spine if your fall was significant. Most calcaneus fractures involve the subtalar joint (the joint just below the ankle that controls side-to-side foot motion), which makes them harder to fix and slower to heal. Bruising, dramatic swelling, and skin blistering around the heel are common in the first few days.

The mechanism is almost always unmistakable — a fall from a ladder, a roof, or a significant height that lands squarely on your heels. The pain is immediate and severe. You cannot put weight on the foot, and within hours the heel swells to nearly twice its normal width, with bruising that spreads across the sole and up both sides of the ankle. In high-energy injuries, fluid-filled blisters (fracture blisters) form over the swollen skin within the first 24 to 48 hours — a sign that the soft tissues are under significant stress.

If both heels were hit, you may also have low-back pain — the same axial force that broke the calcaneus can crack a lumbar vertebra, and your provider will check your spine before focusing solely on the feet. The heel itself feels wider and flatter than normal on exam, and pressing on the sides of the bone reproduces sharp pain.

Diagnosis starts with X-rays — a side view of the heel and a special bottom-up view (the Harris view) that shows the bone's overall shape. A CT scan is then essential for surgical planning: it spells out exactly which parts of the joint are involved (using the Sanders classification), the fracture pattern, and how many pieces are involved. If you fell from significant height, your surgeon will also order a lower-back X-ray — the same force that broke your heel can crack a vertebra.

For fractures that have both shifted and broken into the heel-bone's joint surface (Sanders grades II through IV), in patients healthy enough to handle the recovery, surgery is usually the right call. The goal is to put the joint pieces back in alignment and hold them there with plates and screws — known as ORIF (open reduction and internal fixation).

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language