Anatomy of the Calcaneus

The calcaneus is the largest tarsal bone in the foot and is well designed to sustain high tensile, bending, and compressive forces. However, high instantaneous loads often result in fracture. Any treatment of calcaneal fractures requires a working knowledge of the anatomy. The major neurovascular structures are located medially and are well insulated by the medial soft tissues. These structures are at risk, however, during medial approaches to the calcaneus. Laterally, there are several bony landmarks that are palpable primarily because of the relative paucity of the soft-tissue elements. Lateral approaches to the calcaneus have been associated with the areas of skin necrosis that may be related to the arterial anatomy. The calcaneus has four articular surfaces. The congruity of these articular surfaces and their relationship to one another can be assessed roentgenographically. With adequate knowledge of the bony anatomy of the calcaneus and its soft tissue envelope, a rational approach in assessment and treatment of calcaneal fractures can be developed.