Differential Diagnoses

  • Fracture, anterior process of calcaneus
  • Lateral ankle sprain
  • Lateral talar process fracture
  • Os calcaneus secundarius

Figure 2.

Diagnosis
This patient experienced a fracture of the anterior process of calcaneus.

Learnings/What to Look for

  • Anterior calcaneal process fractures are the result of an inversion and plantarflexion injury. This represents an avulsion fracture of the bifurcate ligament
  • Accessory ossicle (os calcaneus secundarius) can be difficult to distinguish from an anterior process fracture
  • Anterior calcaneal process fractures can be missed using plain radiography. Point tenderness over the calcaneal cuboid joint may aid in diagnosis
  • Undiagnosed fractures can result in nonunion

Pearls for Urgent Care Management and Considerations for Transfer

  • Small, nondisplaced fractures can be managed with nonweight bearing with or without a short leg case for 4–6 weeks
    • Patients can be treated on site or referred immediately for orthopedic care, with follow-up in either setting according to the provider’s expertise and available resources
  • Patients with large or displaced fractures may require operative treatment and should be transferred to an emergency room

Acknowledgment: Images courtesy of Teleradiology Specialists.

A 32-Year-Old Woman with Ankle Pain After a Fall
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