Calcaneal stress fractures, along with stress fractures of the lateral malleolus, are considered low-risk stress fractures with minimal risk of progression and complication.
Classic history and presentation: These fractures classically present as exercise-induced heel pain following long periods of repeated stress or long-distance running. They are also noted in older, less active patients with chronic medical problems and/or poor bone density.
Prevalence: Few studies with large sample sizes have attempted to characterize the true prevalence in the general population. However, they represent a common injury in both athletes and military members. They were found to comprise 20% of foot stress fractures in male military recruits and 39% in females.
Risk factors: Female sex and poor bone density have been associated with greater rates of stress fractures; however, little data exists on a specific association with calcaneal stress fractures. Calcaneal stress fractures are seen most often in military recruits that frequently experience sudden changes in the level of physical stress.
Grade / classification system: Stress fractures can be classified by MRI imaging characteristics –
- I: Endosteal marrow edema
- II: Periosteal edema and endosteal marrow edema
- III: Muscle edema, periosteal edema, and endosteal marrow edema
- IV: Visible fracture line(s)