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

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.