Treatment of Calcaneal Fractures

Initial Diagnostic Imaging

The American College of Radiology recommends obtaining standard radiographs, including anteroposterior, lateral, oblique, and axial calcaneal (Harris-Beath) views, as the first-line imaging modality to diagnose calcaneal fractures and distinguish intra-articular involvement 1
CT is reserved for complex fractures to evaluate the true extent of osseous injury and surgical planning, not as initial screening, according to the Journal of the American College of Radiology 1

Administer paracetamol regularly unless contraindicated, as recommended by Praxis Medical Insights 2
Use opioid analgesia cautiously, particularly in trauma patients with renal dysfunction, as suggested by Praxis Medical Insights 2
Consider single-shot or continuous femoral/fascia iliaca nerve blocks for superior pain relief, according to Praxis Medical Insights 2
Tongue-type calcaneus fractures demand intervention within 24 hours due to potential skin compromise from the displaced posterior fragment, as stated by Praxis Medical Insights 2

Proceed with ORIF once soft tissue swelling subsides, as anatomic reduction of calcaneal shape and subtalar joint congruity correlates with satisfactory functional outcomes, according to Praxis Medical Insights 2

Immobilize initially in a splint or cast, as recommended by Praxis Medical Insights 2
Transition to removable cast boot when soft tissues permit, according to Praxis Medical Insights 2
Initiate physical therapy focusing on range of motion restoration and progressive strengthening, as suggested by Praxis Medical Insights 2
Non-weightbearing period varies by fracture pattern and fixation stability, typically 8-12 weeks, according to the Journal of the American College of Radiology 1

Perform individualized osteoporosis risk assessment in patients >65 years, evaluating age >70, low BMI, weight loss, physical inactivity, corticosteroid use, and previous fragility fractures, as recommended by the American College of Internal Medicine 3, 4
Obtain DXA scanning for patients at increased osteoporosis risk who are candidates for drug therapy, according to the American College of Internal Medicine 3, 4
Calcaneal fractures from low-energy mechanisms suggest underlying osteoporosis requiring treatment, as stated by the American College of Internal Medicine 3, 4