The calcaneus is foot’s biggest bone, also known as the heel bone. Did you know that it is the most commonly fractured tarsal bone of the foot?  Its structure could be compared to an egg: it has a hard, rigid shell, known as the cortical bone, and a soft center, made up of cancellous bone. So why is it called the Don Juan fracture? Read on.

   Calcaneal fractures are usually the result of high-energy trauma or impact, such as a fall from a height (e.g., from a ladder or a roof) or a motor vehicle accident. Patients with osteoporosis (weak bones) are at a much greater risk for calcaneal fracture because of their decreased bone density.   

   The severity of the fracture depends of its location: When the fracture crosses into the joint, this tends to predict a worse fracture, meaning it will be harder to repair, tends to have more complications, and ultimately carries with it a worse prognosis. 

   A patient with this type of injury will have pain, bruising, swelling and his heel can seem to be wider than usual. Calcaneal fractures are best diagnosed with computed tomography (CT or CAT scan), although X-rays will usually be taken first.  

   If the fracture does not extend into the joint, there is a greater likelihood that surgical repair will not be required, and the foot and leg (below the knee) will be immobilized with a cast for 6-8 weeks.  However, if the fracture extends into the joint but is not displaced, surgery may or may not be required, and the treatment, via cast immobilization along with non-weight bearing on the affected foot, can last for as long as three months.

   If the fracture extends into the joint and is displaced, surgical management will almost always be necessary. After such injuries, arthritis is a very common complication.

   I will end this capsule with a fun fact about calcaneal fractures. Besides the Don Juan fractures, did you know that it is also known as ‘’Lover’s fracture’’? Effectively, it is the fracture a lover could get by jumping down the balcony of his mistress not to get caught by her husband! This being said, be careful lovers!

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