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?

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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.

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

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