Review Question - QID 215798

The patient is presenting with a calcaneus stress fracture, which is best treated with boot immobilization and non-weightbearing.

Calcaneus stress fractures are often associated with a sudden increase in physical activity, as well as prolonged weightbearing in obese patients. They also occur in patients who have recently undergone hip or knee arthroplasty due to increased activity in a previously afflicted extremity and altered mechanics. Initial treatment consists of activity modification, CAM boot immobilization, and non-weightbearing.

Brian and Mahraj reviewed imaging techniques for the calcaneus. They state the complex anatomy of the calcaneus necessitates advanced imaging with CT and MRI to identify pathology. However, plain radiographs remain the foundation of diagnostic imaging.

Welck et al. reviewed stress fractures of the foot and ankle. They state calcaneus fractures are often the cause of exercised induced heel pain and are the second most common stress fracture in military recruits, following metatarsal fractures. They recommended activity modification and non-weightbearing as the first-line treatment.

Figure A is a lateral radiograph of the right ankle with a sclerotic region of the calcaneus consistent with a stress fracture. Figure B is a sagittal T1 MRI of the ankle with a hypointense lesion in the calcaneus consistent with a stress fracture.

Incorrect answers
Answer 1: Plantar fascia stretching is an appropriate first-time treatment for plantar fasciitis.
Answer 2: Eccentric Achilles strengthening is appropriate for Achilles tendonitis.
Answer 4: Closed reduction and percutaneous fixation is a treatment option for displaced tongue-type fractures with a concerning soft tissue status.
Answer 5: Activity as tolerated would not be appropriate in the setting of a stress fracture.