[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) › Calcaneus [Skeletal system](https://durgical.com/en/anatomy/system/skeletal-system/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Calcaneus The calcaneus, or heel bone, is the largest bone of the foot; it takes weight at each step and anchors the Achilles tendon. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=lower_limb&select=calcaneus&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The heel bone, the largest bone in the foot. The talus sits on top of it and the Achilles tendon attaches to its back. ## What it does Takes the impact when the heel strikes the ground and works as a lever for the calf muscles. ## Key points - Böhler angle (normally about 20–40°) falls when a fracture depresses the posterior facet; the Gissane angle increases - After a fall from height with a calcaneal fracture, a fracture of the other heel and of the thoracolumbar [spine](https://durgical.com/en/anatomy/region/spine/) is looked for - The sustentaculum tali holds up the talar head; the flexor hallucis longus tendon runs in a groove under it - Calcaneal apophysitis (Sever disease): heel pain in active children at the growth plate where the Achilles tendon pulls ## Key facts **Joints with** Talus (subtalar joint); cuboid (calcaneocuboid joint) **Landmarks** Calcaneal tuberosity (Achilles tendon); medial and lateral processes; sustentaculum tali; fibular trochlea; forms sinus tarsi with talus ## Relations **Above** [Talus](https://durgical.com/en/anatomy/talus/) at the subtalar joint, with the sinus tarsi opening laterally between the two bones **Behind** [Achilles tendon](https://durgical.com/en/anatomy/calcaneal-tendon/) on the middle of the posterior surface, with the retrocalcaneal bursa between the tendon and the upper bone **Below** [Plantar fascia](https://durgical.com/en/anatomy/plantar-aponeurosis/), [abductor hallucis](https://durgical.com/en/anatomy/abductor-hallucis/), [flexor digitorum brevis](https://durgical.com/en/anatomy/flexor-digitorum-brevis/) and abductor digiti minimi from the medial and lateral processes; the heel fat pad **Medial** Tarsal tunnel: the [tibial nerve](https://durgical.com/en/anatomy/tibial-nerve/) divides into the medial and lateral plantar nerves beside the posterior tibial vessels; [flexor hallucis longus](https://durgical.com/en/anatomy/flexor-hallucis-longus/) under the sustentaculum **Lateral** Fibular tendons, with the fibular trochlea between [fibularis brevis](https://durgical.com/en/anatomy/fibularis-brevis-muscle/) (above) and [fibularis longus](https://durgical.com/en/anatomy/fibularis-longus-muscle/) (below); the [calcaneofibular ligament](https://durgical.com/en/anatomy/calcaneofibular-ligament/); the [sural nerve](https://durgical.com/en/anatomy/sural-nerve/) **In front** [Cuboid](https://durgical.com/en/anatomy/cuboid-bone/) at the calcaneocuboid joint; the [bifurcate ligament](https://durgical.com/en/anatomy/bifurcate-ligament/) from the anterior process ## How to find it The tuberosity is felt at the back and underside of the heel. About a finger's breadth below the tip of the medial malleolus lies the sustentaculum tali; below the lateral malleolus the fibular trochlea may be felt between the two fibular tendons. The medial process under the heel is the usual point of tenderness in plantar fasciitis. ## Examination - Calcaneal squeeze test: pain on squeezing the heel from both sides suggests a stress fracture, or apophysitis in a child ## On imaging Lateral and axial (Harris) views; Böhler and Gissane angles are measured on the lateral. CT for intra-articular fractures, graded on the posterior facet (Sanders classification). A stress fracture shows as a sclerotic or oedema band across the back of the body, perpendicular to the trabeculae. ## Common problems - Fracture, usually from a fall from a height or a car crash. It can damage the joint under the talus. - Heel pain, most often from plantar fasciitis at the bottom of the heel. - Stress fractures in runners and military recruits; a bony bump at the back of the heel (Haglund's deformity) that rubs the Achilles tendon. ## How it is diagnosed A physical exam; X-rays; CT for fractures; MRI for stress fractures. ## Treatment - Many fractures and most heel pain: rest, a boot or cast, then gradual walking and physical therapy. - Displaced fractures: surgery with plates or screws; sometimes a later fusion of the joint under the talus. - A bone graft from the patient or a donor is sometimes used to fill gaps in crushed bone. ## Clinical notes - Intra-articular fractures often leave subtalar arthritis and a widened heel that rubs on the fibular tendons - Anterior process fracture after an inversion injury is easily mistaken for a sprain - Swelling and fracture blisters often delay surgery for days after the injury ## Anatomical variants - A lucent triangle in the body on the lateral X-ray (pseudocyst) is a normal area with fewer trabeculae - Calcaneonavicular coalition, seen as the anteater sign on the lateral view ## Development The first tarsal bone to ossify, before birth. The posterior apophysis appears in mid-childhood, normally looks dense and fragmented (not a fracture) and fuses in the mid-teens. ## Related conditions - [Plantar Fasciitis](https://durgical.com/en/conditions/plantar-fasciitis/) - [Achilles tendon rupture](https://durgical.com/en/conditions/achilles-tendon-rupture/) - [Diabetic foot](https://durgical.com/en/conditions/diabetic-foot/) - [Osteomyelitis](https://durgical.com/en/conditions/osteomyelitis/) - [Clubfoot (talipes equinovarus)](https://durgical.com/en/conditions/clubfoot/) - [Pressure injury (pressure ulcer)](https://durgical.com/en/conditions/pressure-injury/) - [Marine envenomations and seafood poisoning (ciguatera, scombroid, jellyfish, stingray)](https://durgical.com/en/conditions/marine-envenomations-and-seafood-poisoning/) - [Mycetoma (actinomycetoma and eumycetoma)](https://durgical.com/en/conditions/mycetoma/) ## Test yourself Think of the answer, then tap the question to see it. ## What happens to the Böhler angle in a calcaneal fracture that depresses the posterior facet? It falls below its normal range of about 20–40°; the Gissane angle increases. ## After a fall from height with a calcaneal fracture, which other injuries are looked for? A fracture of the other heel and of the thoracolumbar spine. ## Which tendon runs in a groove under the sustentaculum tali? The flexor hallucis longus tendon. ## What is Sever disease? Calcaneal apophysitis: heel pain in active children at the growth plate where the Achilles tendon pulls. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/calcaneus/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** calcaneus TA2 1468 **Official Spanish (DeCS)** Calcáneo DeCS D002111 **English (TA2)** Calcaneus **Also called** calcaneal bone ## Related - [Achilles tendon](https://durgical.com/en/anatomy/calcaneal-tendon/) - [Heel bursae](https://durgical.com/en/anatomy/subtendinous-calcaneal-bursa/) - [Talus](https://durgical.com/en/anatomy/talus/) - [Cuboid](https://durgical.com/en/anatomy/cuboid-bone/) - [Talocalcaneal interosseous ligament](https://durgical.com/en/anatomy/talocalcaneal-interosseous-ligament/) - [Spring ligament](https://durgical.com/en/anatomy/plantar-calcaneonavicular-ligament/) - [Plantar fascia](https://durgical.com/en/anatomy/plantar-aponeurosis/) - [Plantar arteries](https://durgical.com/en/anatomy/medial-plantar-artery/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=23176); [Anatomy, Bony Pelvis and Lower Limb: Calcaneus](https://www.ncbi.nlm.nih.gov/books/NBK519544/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/calcaneus/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/calcaneus/