Imaging Case of the Week 104

The following lateral ankle x-ray is from a 60 year old patient who developed a sudden pain in his right heel while playing golf. What can be deduced from the x-ray?

lateral ankle x-ray

Ankle x-ray lateral view

[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The lateral view of the ankle shows an avulsion fracture of the calcaneal tuberosity. This is a significant injury as it involves insertion of the Achilles tendon.

Avulsion fracture of calcaneal tuberosity

This patient underwent operative reduction and tendon repair.

Calcaneal tuberosity avulsion fractures:

  • Achilles tendon is pulled from its insertion
  • Patient presents with pain and swelling in the heel
  • Resisted plantar flexion will be weak because of the involvement of the Achlles tendon.
  • Because of limited overlying soft tissue on the tuberosity, a large displaced avulsion fragment may endanger the skin.
  • Surgical repair of the avulsion fragment is indicated in following instances: (1) tethering of skin over the heel (2) torn Achilles tendon (3) avulsion fracture involving the articular surface of the calcaneus (4) when a prominent posterior portion of the calcaneus is going to affect shoe wear.

Reference: Rockwood and Green’s Fractures in adults