The calcaneus is the heel bone, the largest tarsal bone, and the primary weight-bearing bone of the hindfoot. Its posterior tuberosity bears the Achilles tendon insertion and weight-bearing surface. Its superior surface has three articular facets for the talus (the subtalar joint) with the sinus tarsi between the posterior and middle facets. The sustentaculum tali supports the talus medially and is the landmark for the spring ligament and FHL groove.
Calcaneal fractures from height falls (Sanders classification by CT — Types I-IV by posterior facet fragmentation pattern) are the most common tarsal fracture. Non-operative management produces better outcomes for Types I-II; ORIF through the extensile lateral approach is standard for Types III-IV in physiologically fit patients. Subtalar arthritis after calcaneal fracture malunion is the primary long-term complication requiring subtalar fusion.
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