This male patient presents to urgent care after, he claims, falling from a ladder. He refuses to give further details, except to say that the distance he fell was “not high.”

View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

The obvious diagnosis is calcaneal fracture. However, it is important to note that as many as 7% of patients with calcaneal fracture may have fracture of the contralateral heel.

Given the appropriate mechanism of injury (i.e., a fall from an adequate height), care must be taken to thoroughly examine both lower extremities to exclude the presence of bilateral injuries.

Acknowledgment: Case presented by Nahum Kovalski, BSc, MDCM.