Occult Fracture of the Calcaneus in Toddlers

Five children 14-33 months of age were treated for calcaneal fractures. All had a history of trauma with limping or refusal to walk. Physical examination could not localize the fracture. Initial radiographs were negative. There were no signs of systemic illness. They were treated with long-leg casts. Radiographs after 2 weeks revealed an arc of sclerosis across the tuberosity of the calcaneus. In no case was a bone scan instrumental in making the diagnosis. Awareness of calcaneal fractures in the child younger than 36 months can prevent the routine use of bone scans to make the diagnosis.