Calcaneal stress fractures in civilian patients

an epidemiological study

Abstract

Objective: To conduct a retrospective magnetic resonance imaging (MRI) analysis of calcaneal stress fractures and construct an epidemiological profile of these injuries. Methods: Of 258 MRIs analyzed, nine were consistent with calcaneal stress fractures. These were evaluated by two investigators to confirm the diagnosis. The calcaneus was divided into three anatomical regions: anterior calcaneus (delimited by the angle of Gissane), mid-calcaneus (delimited by the angle of Gissane and tuberosity of the posterior facet), and posterior calcaneus (delimited by the tuberosity of the posterior facet). Fractures were classified as low-grade (grade I, when associated with periosteal edema; II, endosteal; III, muscular) or high-grade (grade IV, when there was a visible fracture line on MRI). Results: The average patient with a calcaneal stress fracture was an overweight (66.7%) female (66.7%) amateur athlete (66.7%), with a left-sided (55.6%) grade IV fracture (77.8%) of the posterior portion of the calcaneus (66.7%), sustained while running (77.8%), and took 1 to 2 years to be diagnosed (66.7%). Conclusion: Calcaneal stress fractures are more frequent in women, amateur athletes, middle age, and in those with overweight. Younger patients usually present with grade I, II, or III fractures, while middle-aged patients present most often with grade IV fractures; lesions tend to be more common in the anterior region than in the mid- or posterior calcaneus. Level of Evidence IV; Therapeutic Studies; Case Series.