# Calcaneus Fracture > Calcaneus fracture for NEET-PG Orthopaedics: fall from height, Essex-Lopresti types, Bohler angle, Sanders CT staging, subtalar arthritis risk. - Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/calcaneus-fracture - Exam / course: NEET-PG · Subject: Orthopaedics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Calcaneus Fracture", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/calcaneus-fracture ## Direct answer Landing on the heels from a height drives the talus down into the calcaneus, splitting the largest tarsal bone — the fracture of scaffolds, falls and psychiatric emergencies. Two families matter: extra-articular fractures of tuberosity and anterior process, and the commoner intra-articular fractures that shear and then crush the posterior facet. The Essex-Lopresti classification separates joint-depression from tongue-type patterns; Böhler's angle, normally 25 to 40 degrees, flattens as the joint collapses, and coronal computed tomography generates the Sanders classification — grades I to IV by the number of posterior facet fragments — which predicts outcome. Because the same fall compresses the spine, every calcaneal fracture earns a thoracolumbar survey. ## What you must remember - **Mechanism and company:** axial load from a fall; roughly one in ten is bilateral, and the same fall brings thoracolumbar compression fractures and other injuries — image the spine, palpate the other heel, always. - **Bedside signs:** heel widening, tenderness on side-to-side compression, and plantar arch ecchymosis — a near-diagnostic finding. - **Essex-Lopresti types:** joint-depression — the posterior facet driven down as a separate fragment; tongue type — the articular fragment stays attached to the tuberosity and Achilles tendon, sometimes reducible percutaneously by levering. - **Böhler angle:** formed by lines from the highest point of the tuberosity to the posterior facet apex and on to the anterior process; normal 25-40 degrees, and a flattened angle marks collapsed architecture. - **Sanders classification:** coronal computed tomography through the posterior facet — I non-displaced regardless of comminution, II two fragments, III three, IV four or more — outcome worsens with grade, and grade IV is bad enough after fixation that primary subtalar fusion is considered. - **Treatment defaults:** non-operative for non-displaced fractures and poor candidates — boot, no weight-bearing until early union; displaced intra-articular fractures in good candidates get open reduction through an extensile lateral approach timed to soft-tissue recovery. - **Complication ledger:** subtalar stiffness and arthritis (the dominant long-term problem), wound-edge necrosis of the lateral flap, sural nerve injury, peroneal impingement under the widened wall, chronic regional pain. ## From skywalk to subtalar joint A 40-year-old construction worker falls three metres onto his right heel. The heel is broad, bruised under the arch, exquisite to side-to-side compression. The lateral film shows a crushed posterior facet with a Böhler angle of 12 degrees, and computed tomography renders the facet in three fragments — Sanders III. The spine films are normal and the left heel intact: the survey has earned its keep. The soft tissue is now the clock — elevation, blisters watched, surgery waiting for wrinkled skin at a week to ten days, the pilon discipline exactly. Operation restores what the fall flattened: through an extensile lateral L-shaped incision, the joint-depression fragment is lifted, the facet rebuilt against the sustentaculum, lateral wall width corrected, and plate and screws applied. Consent counselling is honest — even a perfect reconstruction usually surrenders much subtalar motion, and arthritis may yet demand fusion. Contrast the diabetic heavy smoker: his soft tissues argue for a boot, strict non-weight-bearing and acceptance of a stiff, broad heel, because in calcaneal surgery wound disaster outweighs anatomic imperfection more often than the reverse. ## How the exam frames it The numbers come first: Böhler's 25-40 degrees and Sanders I-IV, both asked as one-liners. The trap comes second — the stem asking "what else will you image?" expects the spine, not a more detailed foot film. The third distinguishes Essex-Lopresti's two calcaneal patterns — a name that also belongs to a forearm injury (radial head fracture with distal radioulnar disruption), a collision of eponyms examiners enjoy. Indian wards give the epidemiology: falls from unfinished buildings, terraces and wells, often first splinted by bone-setters, so the surgeon meets the fracture through swollen, oil-marked skin — patience with soft tissue before any incision is this page's practical Indian addition. ## Frequently asked questions ### What is Bohler angle and its normal value? The angle between a line from the highest point of the calcaneal tuberosity to the posterior facet apex and a line from that apex to the anterior process; normal is 25-40 degrees, and flattening indicates collapse. ### On what is the Sanders classification based? Coronal computed tomography of the posterior facet of the subtalar joint, counting fragments: I non-displaced, II two fragments, III three, IV four or more — prognosis falls with grade. ### Why must the spine be imaged in calcaneal fracture? Because the axial load that fractured the heel frequently compresses the thoracolumbar vertebrae, and spinal injuries are missed while the painful foot dominates attention. ### How are displaced intra-articular fractures treated in fit patients? Open reduction and internal fixation through an extensile lateral approach once the soft tissues recover, aiming to restore the posterior facet, height and heel width. ### What is the principal long-term complication? Subtalar stiffness and post-traumatic arthritis, often followed by a need for subtalar or triple arthrodesis in symptomatic patients.