Management of Small Calcaneal Fractures

Initial Diagnostic Evaluation

The American College of Radiology recommends obtaining standard radiographs including anteroposterior, lateral, and axial Harris-Beath views to assess fracture displacement and intra-articular involvement 1, 2
The axial calcaneal view increases specificity in diagnosing calcaneal fractures and sensitivity in distinguishing intra-articular from extra-articular patterns 2
CT scanning is reserved for complex fractures requiring surgical planning, not for initial evaluation of small fractures 2

The standard of care for small, non-displaced or minimally displaced calcaneal fractures is non-operative treatment, according to Praxis Medical Insights 1

Paracetamol (acetaminophen) should be prescribed regularly unless contraindicated 1
Opioid analgesia should be used cautiously, particularly in patients with renal dysfunction (approximately 40% of trauma patients have GFR <60 mL/min/1.73m²) 1
Peripheral nerve blocks should be considered for severe pain, though this is more commonly needed for displaced fractures 3

Initial immobilization in a cast or removable boot is recommended 1
Transition to protected weight-bearing as pain allows, typically over 6-8 weeks 3

Tongue-type fractures with skin compromise require urgent intervention within 24 hours 1
Open fractures require soft tissue management 1

Associated abrasions should be cleaned with simple saline solution without additives 1
Antibiotic coverage with Cefazolin, or clindamycin if penicillin-allergic, should be initiated 1
Gram-negative coverage should be added for more severe soft tissue injuries 1
Negative pressure wound therapy should be considered for significant abrasions 1

Physical therapy should be initiated once the immobilization period ends to restore range of motion and strength 1
Patients should be monitored for chronic pain and functional limitations as long-term complications 1