Calcaneus (Heel Bone) Fractures-OrthoInfo - AAOS Copyright 2016 American Academy of Orthopaedic Surgeons Calcaneus (Heel Bone) Fractures A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event—such as a car crash or a fall from a ladder—when the heel is crushed under the weight of the body. When this occurs, the heel can widen, shorten, and become deformed. Calcaneus fractures can be quite severe. Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. But even with appropriate treatment, some fractures may result in long-term complications, such as pain, swelling, loss of motion, and arthritis. Anatomy Normal foot anatomy. The bones of the feet are commonly divided into three parts: the hindfoot, midfoot, and forefoot. Seven bones — called tarsals — make up the hindfoot and midfoot. The calcaneus (heel bone) is the largest of the tarsal bones in the foot.

It lies at the back of the foot (hindfoot) below the three bones that make up the ankle joint. These three bones are the: Tibia — shinbone Fibula—smaller bone in the lower leg Talus—small foot bone that works as a hinge between the tibia and the fibula Together, the calcaneus and the talus form the subtalar joint. The subtalar joint allows side-to-side movement of the hindfoot and is especially important for balance on uneven surfaces. Top of page Description Calcaneus fractures are uncommon. Fractures of the tarsal bones account for only about 2% of all adult fractures and only half of tarsal fractures are calcaneus fractures. A fracture may cause the heel bone to widen and shorten. In some cases, a fracture may also enter the subtalar joint in the foot. When this occurs, damage to the articular cartilage covering the joint may cause long-term complications such as chronic pain, arthritis, and loss of motion. Severity The calcaneus is most often fractured during a: Fall from a height Twisting injury to the ankle Motor vehicle collision The severity of a fracture can vary.

For example, a simple twist of the ankle may result in a single crack in the bone. The force of a head-on car collision, however, may result in the bone being shattered (comminuted fracture). Similar fractures can result from different mechanisms. For example, if you land on your feet from a fall, your body's weight is directed downward. This drives the talus bone directly into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus if the heel is crushed against the floorboard. In both cases, the fracture patterns are similar. As a rule, the greater the impact, the more the calcaneus is damaged. In a high-energy fracture, other injuries, such as fractures of the spine, hip, or other heel, can occur. (Left) In some injuries, the talus is forced downward and acts like a wedge to fracture the calcaneus. (Right) This computerized reconstruction of a calcaneus fracture shows the amount of damage that can occur. Heel deformity Inability to put weight on the heel or walk With some minor calcaneus fractures, the pain may not be enough to prevent you from walking — but you may limp.

This is because your Achilles tendon acts through the calcaneus to support your body weight. If, however, your calcaneus is deformed by the injury, your muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently. Top of page Doctor Examination It is important that you tell your doctor the circumstances of your injury. For example, if you fell from a ladder, how far did you fall? It is also important that you tell your doctor if you have any other injuries or medical problems, such as diabetes, or if you take medications or smoke. Physical Examination After discussing your symptoms and medical history, your doctor will perform a careful examination. He or she will: Examine your foot and ankle to see if your skin was damaged or punctured from the injury. Check your pulse at key points of the foot to be sure that there is a good blood supply to the foot and toes. Check to see if you can move your toes, and can feel things on the bottom of your foot. Determine whether you have injured any other areas of your body by examining the rest of your injured leg, your other leg, pelvis, and spine.

Tests Imaging studies will help confirm the diagnosis of a calcaneus fracture: X-rays. This test is the most common and widely available diagnostic imaging technique. X-rays create images of dense structures, such as bone. An x-ray can show if your calcaneus is broken and whether the bones are displaced. Computed tomography (CT) scans. Because of the complex anatomy of the calcaneus, a CT scan is routinely ordered after a fracture has been diagnosed on x-ray. A CT scan will produce a more detailed, cross-sectional image of your foot and can provide your doctor with valuable information about the severity of your fracture. This information will help your doctor recommend the best plan for treatment. Your doctor may share both your x-rays and CT scans with you to help you better understand the nature and severity of your injury. Your doctor will consider several factors in planning your treatment, including: The cause of your injury Your overall health The severity of your injury The extent of soft tissue damage Because most calcaneus fractures cause the bone to widen and shorten, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better outcomes. In most cases, recreating the normal heel anatomy involves surgery.

Your doctor will discuss the different treatment options with you. Nonsurgical Treatment Nonsurgical treatment may be recommended if the pieces of broken bone have not been displaced by the force of the injury. Immobilization. A cast, splint, or brace will hold the bones in your foot in proper position while they heal. You may have to wear a cast for 6 to 8 weeks — or possibly longer. During this time, you will not be able to put any weight on your foot until the bone is completely healed. Surgical Treatment If the bones have shifted out of place (displaced), your doctor may recommend surgery. Surgery to repair a calcaneus fracture can restore the normal shape of the bone but is sometimes associated with complications, such as wound healing problems, infection, and nerve damage. Nonsurgical treatment of some fractures, however, can also lead to long-term complications, such as pain, arthritis, and a limp. Your doctor will review the details of your injury and talk with you about the risks and benefits of surgical versus nonsurgical treatment. Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery.

Elevating your leg and keeping it immobilized for several days will decrease swelling. It will also give stretched skin a chance to recover. Waiting before the operation may improve your overall recovery from surgery and decrease your risk of infection. Open fractures, however, expose the fracture site to the environment and must be treated immediately. They require surgery to clean the wound and remove damaged tissue Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon splits away from the bone (avulsion). For this type of fracture, emergent surgery can decrease the risk of injury to the skin around the Achilles tendon. Surgical procedure. The following procedures are used for various types of calcaneus fractures: Percutaneous screw fixation. If the bone pieces are large, they can sometimes be moved back into place without making a large incision. Special screws are then inserted through small incisions to hold the fracture together. Open reduction and internal fixation. During this operation, an open incision is made to reposition (reduce) the bones into their normal alignment. They are held together with wires or metal plates and screws. (Left) A displaced fracture of the calcaneus.

(Right) The fracture has been reduced and the bones held in place with screws. In this x-ray, the bone fragments have been realigned and held in place with metal plates and screws. Top of page Recovery Bones have a remarkable capacity to heal. The more severe your injury, however, the longer your recovery may be. Patients with more severe fractures are also more likely to suffer some degree of permanent loss of function, regardless of treatment. Pain Management After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor.

As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery. Rehabilitation Whether your treatment is surgical or nonsurgical, your rehabilitation will be very similar. The time it takes to return to daily activities will vary depending on the type and severity of the fracture and whether you have other injuries. Some patients can begin weight-bearing activities a few weeks after injury or surgery; others may need to wait 3 months or more before putting weight on the heel. Most patients are able to begin partial weight bearing between 6 and 10 weeks after injury or surgery. Early motion. Many doctors encourage motion of the foot and ankle early in the recovery period. For example, you may be instructed to begin moving the affected area as soon as your pain allows. If you have had surgery, you may be instructed to begin moving the affected area as soon as the wound heals to your doctor's satisfaction. Physical therapy. Specific exercises can help improve the range of motion in your foot and ankle, and strengthen supporting muscles. Although they are often painful at the beginning and progress may be difficult, exercises are required in order for you to resume normal activities. Weight bearing.

When you begin walking, you may need to use crutches, a cane, or a walker and/or wear a special boot. It is very important to follow your doctor's instructions for walking on your foot. If you put weight on your foot too soon, the bone pieces may move out of place and you might require surgery. If you have had surgery, the screws might loosen or break and the bone may collapse. This may not occur the first time you walk on it but, if the bone is not healed and you continue to bear weight, the metal will eventually break. Six months after surgery, this patient's hardware has failed. Several screws have broken and the calcaneus has collapsed. This patient required major reconstruction, and today walks with a limp and has little motion in the foot. Complications Complications often occur with calcaneus fractures. Minor complications include: Small or temporary areas of delayed wound healing Nerve irritation around the incision Tendon irritation Failure of the wound to heal Infection Posttraumatic arthritis (with or without surgery) It is important to tell your doctor if you are a smoker. Smoking affects both bone and wound healing. With or without surgery, your bone may take longer to heal if you smoke.

Additional surgery is usually required in cases of infection or wound healing complications. If all attempts to resolve an infection or a wound healing complication fail, an amputation may be necessary. Top of page Outcomes If your injury is minor, such as a crack in the bone with little muscle damage, you may be able to resume normal activities from 3 to 4 months after surgery. If your fracture is severe, however, it may take from 1 to 2 years before recovery is complete. Despite the best efforts of the doctor and patient, normal foot and ankle motion is rarely regained after a severe fracture and patients do not typically resume their pre-injury level of function. A patient who is not very active might tolerate a foot that is not normal. On the other hand, a patient whose job or recreational activities require a lot of walking or climbing will notice more. Common Problems Top of page Improving Outcomes There is no universal agreement among experts as to the best treatment method for calcaneus fractures. No single method works the same for everyone. Patients whose x-rays show good healing and normal heel anatomy often have ongoing symptoms after treatment.

On the other hand, the calcaneus can look quite deformed on an x-ray, but the patient may have few, if any, symptoms. Studies have compared results in patients whose fractures were treated with and without surgery. Some studies show a significant benefit of surgery, while other studies show less benefit for certain patients. Researchers continue to look for ways to improve the outcomes of treatment for different types of calcaneus fractures, as well as for patients who smoke or have other health considerations. Your doctor will talk with you about the best treatment options in your case. Talus Bone Pictures, Function & Diagram | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Talus The talus is an important bone of the ankle joint that is located between the calcaneus (heel bone) and the fibula and tibia in the lower leg. The shape of the bone is irregular, somewhat comparable to a turtle's hump.

The key function of this bone is to form a connection between the leg and the foot so that body weight may be transferred from the ankle to the leg, enabling a person to walk while maintaining balance. The bone also helps in the movements of the ankle, and together with the calcaneus it facilitates the movements of the foot. Any injury to this critical bone may hamper the movements of the ankle and foot. A major fracture in the bone can cause serious impediment to a person's ability to walk or stand. Compared to most other bones, the talus is deficient in its supply of oxygenated blood. As a result, it takes a long time to repair following a serious injury. Foot Bone Anatomy: Overview, Tarsal Bones - Gross Anatomy, Metatarsal Bones - Gross Anatomy Foot Bone Anatomy Author: Vinod K Panchbhavi, MD, FACS; Chief Editor: Thomas R Gest, PhD more... Share Overview Overview The human foot is a highly developed, biomechanically complex structure that serves to bear the weight of the body as well as forces many times the weight of the human body during propulsion. About 26 bones in the human foot provide structural support.

They can be grouped into 3 parts, as follows [ 1 , 2 ] : The tarsal bones (7) [ 3 , 4 ] The metatarsal bones (5) [ 5 ] The phalanges (14) [ 6 ] Apart from these main bones, the sesamoid bones help improve function and are often found as variants of the accessory bones. The foot itself can be divided into 3 parts: the hindfoot, the midfoot, and the forefoot. The hindfoot is composed of 2 of the 7 tarsal bones, the talus, and the calcaneus; the midfoot contains the rest of the tarsal bones; and the forefoot contains the metatarsals and the phalanges. The images below depict the bones of the foot. Bones of the foot, dorsal and ventral views. Next: Tarsal Bones - Gross Anatomy The tarsal bones are 7 in number. They are named the calcaneus, talus, cuboid, navicular, and the medial, middle, and lateral cuneiforms.

Calcaneus The calcaneus is the largest of the tarsal bones located in the heel of the foot and bears the weight of the body as the heel hits the ground. This bone protrudes out at the back, providing a strong lever for the triceps surae muscles of the calf and helping with plantar flexion and push off during ambulation (see the image below). The calcaneus is roughly 3-dimensionally rectangular in shape, with its long axis directed anteriorly and laterally, and it has 6 surfaces. Ankle joint, lateral view. View Media Gallery Calcaneus, surface anatomy The superior calcaneal surface (see the following images) of the calcaneus has 2 parts: articular and nonarticular. The nonarticular part extends posteriorly to form the heel; it varies in length in different individuals, is convex from side to side, is concave in the anteroposterior axis, and supports a fat pad situated anterior to the calcaneal (Achilles) tendon. The articular part that lies anterior to the nonarticular part of the superior surface has an oval facet; the posterior facet faces superiorly and is also tilted anteriorly.

The articular portion of the superior surface is convex in the anteroposterior axis and articulates with the posterior calcaneal facet on the undersurface of the talus. Superior surface of the calcaneus bone. View Media Gallery At the anterior boundary of the posterior facet is a deep depression, which continues posteromedially in the form of a groove. This groove is called the calcaneal sulcus. It matches the inferior similar sulcus underneath the talus, and both these grooves form a canal in the hindfoot called the sinus tarsi. Just anteromedial to the calcaneal sulcus is another area of articular surface elongated and concave in its long axis that is directed anterolaterally. This articular surface is divided by a transversely oriented notch into a larger facet, called the middle facet, as well as a smaller facet anterior to this, called the anterior facet (see the previous image). The middle facet lies on a medially projecting process of the calcaneus called the sustentaculum tali (see the image below). It articulates with the middle calcaneal facet on the under surface of the talus.

The anterior facet lies on the anterior process of the calcaneus and articulates with the anterior calcaneal facet on the talus. The upper surface, anterior and lateral to the facets, is rough for the attachment of ligaments and for the origin of the extensor digitorum brevis. Medial surface of the calcaneus bone. View Media Gallery The inferior or plantar calcaneal surface is wider posteriorly and convex from side to side. It has a plantar prominence at the back, called the calcaneal tuberosity (see the following image), which has a central longitudinal depression dividing it into a smaller lateral process that is the origin of a part of the abductor digiti minimi (quinti), as well as a larger broader medial process that gives attachment, by its prominent medial margin, to the abductor hallucis, and in front to the flexor digitorum brevis and the plantar aponeurosis. Lateral view of the calcaneus and cuboid bones. View Media Gallery The depression between the processes gives rise to the abductor digiti minimi (quinti).

The rough surface in front of the processes gives attachment to the long plantar ligament and to the lateral head of the quadratus plantae. The plantar calcaneocuboid ligament is attached to a prominent tubercle nearer the anterior part of this surface, as well as to a transverse groove in front of the tubercle. The lateral calcaneal surface (see the image below) is broader posteriorly and becomes narrower anteriorly. It has a small tubercle in the middle, to which the calcaneofibular ligament is attached. Anterior to this tubercle are 2 grooves separated by a ridge, the trochlear process or peroneal (fibular) tubercle. The fibularis (peroneus) brevis tendon lies superior and the fibularis (peroneus) longus tendon lies inferior to the peroneal (fibular) tubercle. Lateral surface of the calcaneus bone. View Media Gallery The medial calcaneal surface (see the first image below) has a deep concavity in the anteroposterior direction in which run the neurovascular structures from the leg into the foot.

Toward the upper and anterior end is a medially oriented horizontal projection, the sustentaculum tali (see the second image below). The sustentaculum tali has an articular surface for the middle calcaneal facet and is grooved inferiorly to house the flexor hallucis longus tendon. Its anterior margin gives attachment to the plantar calcaneonavicular ligament, and its medial margin gives attachment to a part of the deltoid ligament of the ankle joint. Medial surface of the calcaneus bone. View Media Gallery Talus The talus is the second largest tarsal bone, and it is situated above the calcaneus in the hindfoot. This bone is unique in that two thirds of the talar surface is covered with articular cartilage, and neither tendons nor muscles insert or originate from this bone. The talus has 5 articular surfaces, all of which have a weight-bearing function. The talus is composed of 3 parts (the head, neck, body) and 2 processes (the lateral and posterior). The talar head is the portion that articulates mostly with the navicular.

The body includes the dome of the talus at the ankle joint and the posterior facet at the subtalar joint. Between the head and the body is the neck, which does not articulate with the ankle and sits over the sinus tarsi below. The body and neck of the talus are not coaxial, because in the horizontal plane the neck angles medially with a variable angle of declination. Talus, head The talar head looks forward and medialward; its anterior articular or navicular surface is large, oval, and convex. The anteroinferior medial portion of the talar head is quadrilateral or oval and provides articulation with the anterior facet of the calcaneus. This portion of the head is flat and continuous anteriorly with the navicular articular surface (see the images below). Anterior view of the talus and calcaneus bones. View Media Gallery The head of the talus nests within an articulation known as the acetabulum pedis, or foot socket (see image below), as described by Sarrafian.

[ 2 ] This socket is formed by the calcaneal middle and anterior surfaces connected to the large navicular articular surface by the inferior and superomedial calcaneonavicular ligaments. The acetabulum pedis has a variable volume capacity and adapts to the changing position of the talar head during gait. It is hinged laterally by the lateral calcaneonavicular component of the bifurcate ligament and medially by the posterior tibial tendon and the spring ligament. Superior view of the acetabulum pedis. View Media Gallery Talus, neck The neck is directed forward and medialward 15-20º and comprises the constricted portion of the bone between the body and the oval head (see the following image). This portion of the talus is most vulnerable to fracture. The neck has 4 surfaces: (1) superior, (2) lateral, (3) medial, and (4) inferior. Medial surface of the talus bone. View Media Gallery The superior surface of the neck is limited posteriorly by the anterior border of the trochlea of the talus (the dome or body) and anteriorly by the articular surface of the talar head.

The tibiotalar capsule inserts along this superior surface just proximal to the insertion of the capsule of the talonavicular joint. The lateral surface of the neck is concave and is continuous below with the deep groove for the interosseous talocalcaneal ligament. It provides an insertion for the medial aspect of the inferior extensor retinaculum. The inferior surface of the neck forms the roof of the sinus tarsi and sinus canal. The medial surface provides an area for insertion of the talonavicular ligaments. Talus, body The body of the talus is arbitrarily divided into 5 surfaces: (1) lateral, (2) medial, (3) superior, (4) inferior, and (5) posterior. The lateral talar body surface carries a large triangular facet, concave from above downward, for articulation with the lateral malleolus (see the image below). It is continuous above with the superior articular surface and in front of it is a rough depression for the attachment of the anterior talofibular ligament. Along the anterior, inferior, and posterior perimeter of this lateral articular surface is the lateral process, a nonarticular component of the talus.

The lateral talocalcaneal ligament inserts at the inferior tip of the lateral process. Along the anterior border of the triangular lateral process are 2 tubercles for insertion of the anterior talofibular ligament. Along the posteroinferior border of this lateral surface lies a groove for the attachment of the posterior talofibular ligament. Lateral surface of the talus bone. View Media Gallery The medial talar body surface of the body presents 2 areas, superior and inferior(see the following image). The superior portion is occupied by a pear-shaped or comma-shaped articular facet, which is broader anteriorly and is called the medial malleolar facet. It articulates with the medial malleolus of the tibia and is continuous above with the superior articular surface for tibia. The long-axis medial malleolar facet is oriented anteroposteriorly. The inferior portion is nonarticular, and its anterior half is a depressed surface perforated by numerous vascular foramina. Under the tail of the medial malleolar facet, the posterior half of the inferior portion consists of a large oval area that provides insertion for the deep component of the deltoid ligament. Medial surface of the talus bone.

View Media Gallery The superior surface of the talar body is completely covered with articular cartilage for articulation with the tibia. It is shaped like a pulley, with the groove of the pulley termed the trochlea, closer to the medial border. The superior surface is broader in front than behind, convex anteroposterior axis, slightly concave from side to side: in front, it is continuous with the upper surface of the neck of the bone (see image below). Superior surface of the talus bone. View Media Gallery The inferior talar body surface presents 2 articular areas called the posterior calcaneal articular surface and the middle calcaneal articular surface . These articular surfaces, one for the posterior and the other for the middle calcaneal facets, are separated from each other by a deep groove, the sulcus tali. The groove runs obliquely forward and lateralward, becoming gradually broader and deeper in front. In the articulated hindfoot it lies above a similar groove upon the upper surface of the calcaneus, and forms, with it, a canal termed the sinus tarsi, in which lies the interosseous talocalcaneal ligament.

The posterior calcaneal articular surface is large and of an oval or oblong form. It articulates with the corresponding facet on the upper surface of the calcaneus and is deeply concave in the direction of its long axis, which runs forward and lateralward at an angle of about 45° with the median plane of the body. The middle calcaneal articular surface is small, oval in form and slightly convex; it articulates with the upper surface of the sustentaculum tali of the calcaneus(see the first image below). The posterior surface is narrow, and traversed by a groove running obliquely downward and medialward and transmitting the tendon of the flexor hallucis longus (see the second image below). Medial view of the talus and calcaneal bones. View Media Gallery The sulcus for this tendon is flanked by the posterolateral and posteromedial tubercles. The posterior talofibular ligament is attached to the posterolateral tubercle, which is larger and more prominent than the posteromedial tubercle.

The posterolateral tubercle contributes an inferior articular surface that is in continuity with the posterolateral aspect of the posterior calcaneal surface of the talus. An accessory bone, the os trigonum, may be found in connection with the posterolateral tubercle. Talus, articulations The talus articulates with 4 bones: the tibia, fibula, calcaneus, and navicular. Cuboid The cuboid bone is placed on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones. It is cuboidal in shape but has a broader base oriented medially (see the image below). Lateral view of the calcaneus and cuboid bones. View Media Gallery Cuboid, surfaces The dorsal cuboidal surface, directed upward and lateralward, is rough, for the attachment of ligaments. The plantar surface appears in front of a deep groove, the peroneal (fibularis) sulcus, which runs obliquely anteromedially.

It lodges the tendon of the fibularis (peroneus) longus and is bounded behind by a prominent ridge, to which the long plantar ligament is attached. The ridge ends laterally in an eminence, the tuberosity, the surface of which presents an oval facet; on this facet glides the sesamoid bone or cartilage frequently found in the tendon of the fibularis (peroneus) longus. The surface of bone behind the groove is rough, for the attachment of the plantar calcaneocuboid ligament, a few fibers of the flexor hallucis brevis, and a fasciculus from the tendon of the tibialis posterior. The lateral cuboidal surface presents a deep notch formed by the commencement of the peroneal (fibularis) sulcus. The posterior surface is smooth, triangular, and concavoconvex, for articulation with the anterior surface of the calcaneus; its inferomedial angle projects backward as a process, which underlies and supports the anterior end of the calcaneus.

The anterior cuboidal surface, of smaller size, but also irregularly triangular, is divided by a vertical ridge into 2 facets: the medial, quadrilateral in form, articulates with the fourth metatarsal; the lateral, larger and more triangular, articulates with the fifth metatarsal. The medial surface is broad, irregularly quadrilateral, and presents at its middle and upper part a smooth, oval facet, for articulation with the third cuneiform; and behind this (occasionally), a smaller facet, for articulation with the navicular; it is rough in the rest of its extent, for the attachment of strong interosseous ligaments. Cuboid, articulations The cuboid articulates with 4 bones: (1) calcaneus, (2) third cuneiform, (3) fourth metatarsal, and (4) fifth metatarsal. It occasionally articulates with a fifth, the navicular. Navicular bone The navicular bone is located medially in the midfoot between the talus posteriorly and the 3 cuneiform bones anteriorly (see the following image).

It forms the uppermost portion of the medial longitudinal arch of the foot and acts as a keystone of the arch. It is a boat-shaped bone that sits between the talar head and the 3 cuneiform bones. The navicular bone has 6 surfaces. Bones of the foot, larger lateral view. View Media Gallery Navicular bone, surfaces The posterior navicular surface is oval, concave, broader laterally than medially, and articulates with the rounded head of the talus (see the image below). Posterior surface of the navicular bone. View Media Gallery The medial navicular surface slopes posteriorly to end in a rounded prominent tuberosity (see the image below), where a portion of the posterior tibial tendon is inserted. Much of the tuberosity accepts the attachment of the plantar calcaneonavicular (spring) ligament arising from the sustentaculum tali. Superior view of the talus and navicular bones. View Media Gallery The anterior navicular surface is convex from side to side, and subdivided by 2 ridges into 3 facets, for articulation with the 3 cuneiform bones.

The dorsal surface is convex from side to side, and rough for the attachment of ligaments (see the following image). The plantar surface is irregular, and also rough for the attachment of ligaments. The lateral surface is rough and irregular for the attachment of ligaments and occasionally presents a small facet for articulation with the cuboid bone. Dorsal surface of the navicular bone. View Media Gallery Navicular bone, articulations The navicular articulates with 4 bones: the talus and the 3 cuneiforms. It occasionally articulates with a fifth, the cuboid. Cuneiforms The 3 cuneiforms are named the medial, middle, and lateral, and they are convexly shaped on their broader dorsal surfaces. The middle and the lateral cuneiforms are also wedge shaped, so that the apex of each bone points plantarward and toward the center of the foot. The medial cuneiform is convex medially and rounded inferiorly. The medial and lateral cuneiforms project farther distally that the middle cuneiform to create a mortise for the base of the second metatarsal that articulates with the middle cuneiform.

This configuration creates a keystone effect and contributes to the stability of the midfoot. See the following images. Bones of the foot, dorsal and ventral views. View Media Gallery Medial cuneiform overview, surfaces, and articulations The medial cuneiform bone is the largest of the 3 cuneiforms. It is situated at the medial side of the foot, between the navicular behind and the base of the first metatarsal in front. The medial surface of the medial cuneiform is subcutaneous, broad, and quadrilateral. At its anterior inferior edge is a smooth oval impression, into which part of the tendon of the tibialis anterior is inserted; in the rest of its extent, it is rough for the attachment of ligaments. The lateral surface is concave, presenting, along its superior and posterior borders a narrow L-shaped surface, the vertical limb and posterior part of the horizontal limb which articulate with the second cuneiform, whereas the anterior part of the horizontal limb articulates with the second metatarsal bone. The rest of this surface is rough for the attachment of ligaments and part of the tendon of the fibularis (peroneus) longus.

The anterior surface, kidney shaped and much larger than the posterior surface, articulates with the first metatarsal bone. The posterior surface is triangular, concave, and articulates with the most medial and largest of the 3 facets on the anterior surface of the navicular. The plantar surface is rough and forms the base of the wedge; at its back part is a tuberosity for the insertion of part of the tendon of the tibialis posterior. It also gives insertion in front to part of the tendon of the tibialis anterior. The dorsal surface is the narrow end of the wedge and is directed upward and lateralward; it is rough for the attachment of ligaments. The first cuneiform articulates with 4 bones: (1) navicular, (2) second cuneiform, (3) first metatarsal, and (4) second metatarsal. Middle cuneiform overview, surfaces, and articulations The second cuneiform bone, the smallest of the 3, is wedge shaped with a dorsal base and apex plantar. It is situated between the other 2 cuneiforms, and articulates with the navicular behind and the second metatarsal in front.

The anterior surface of the middle cuneiform bone, triangular in form, and narrower than the posterior, articulates with the base of the second metatarsal bone. The posterior surface, also triangular, articulates with the intermediate facet on the anterior surface of the navicular. The medial surface carries an L-shaped articular facet, running along the superior and posterior borders, for articulation with the first cuneiform, and is rough in the rest of its extent for the attachment of ligaments. The lateral surface presents posteriorly a smooth facet for articulation with the third cuneiform bone. The dorsal surface forms the base of the wedge; it is quadrilateral and rough for the attachment of ligaments. The plantar surface, sharp and tuberculated, is also rough for the attachment of ligaments and for the insertion of a slip from the tendon of the tibialis posterior. The medial cuneiform articulates with 4 bones: (1) navicular, (2) first cuneiform, (3) third cuneiform, and (4) second metatarsal.

Lateral cuneiform overview, surfaces, and articulations The anterior surface of the lateral cuneiform is triangular and articulates with the third metatarsal bone. The posterior surface articulates with the lateral facet on the anterior surface of the navicular and is rough below for the attachment of ligamentous fibers. The medial surface of the lateral cuneiform presents an anterior and a posterior articular facet, separated by a rough depression: the anterior, sometimes divided, articulates with the lateral side of the base of the second metatarsal bone; the posterior skirts the posterior border and articulates with the second cuneiform; the rough depression gives attachment to an interosseous ligament. The lateral surface of the lateral cuneiform also presents 2 articular facets, separated by a rough nonarticular area; the anterior facet, situated at the superior angle of the bone, is small and semi-oval in shape, and articulates with the medial side of the base of the fourth metatarsal bone; the posterior and larger one is triangular or oval and articulates with the cuboid; the rough, nonarticular area serves for the attachment of an interosseous ligament.

The 3 facets for articulation with the 3 metatarsal bones are continuous with one another; those facets for articulation with the second cuneiform and navicular are also continuous, but the facet for articulation with the cuboid is usually separate. The dorsal surface is oblong, its posterolateral angle being prolonged backward; whereas the plantar surface is a rounded margin and serves for the attachment of part of the tendon of the tibialis posterior, part of the flexor hallucis brevis, and ligaments. The third cuneiform articulates with 6 bones: (1) navicular, (2) second cuneiform, (3) cuboid, and (4-6) second, third, and fourth metatarsals. Previous View Media Gallery The base at the proximal end is wedge-shaped, articulating proximally with the tarsal bones and by its sides with the contiguous metatarsal bones; its dorsal and plantar surfaces are rough for the attachment of ligaments. The head at the distal end presents a convex articular surface, oblong from above downward, and extending farther backward plantar than dorsal.

Its sides are flattened, and on each is a depression, surmounted by a tubercle, for ligamentous attachment. Its plantar surface is grooved anteroposteriorly (for the passage of the flexor tendons) and marked on either side by an articular eminence continuous with the terminal articular surface. First metatarsal bone The first metatarsal bone is the stoutest and the shortest of the metatarsal bones. The body is strong and of well-marked prismoid form. The base usually has no articular facets on its sides, but occasionally on the lateral side an oval facet exists, by which it articulates with the second metatarsal. Its proximal articular surface is of large size and kidney shaped; its circumference is grooved (for the tarsometatarsal ligaments) and medially gives insertion to part of the tendon of the tibialis anterior; its plantar angle presents a rough, oval prominence for the insertion of the tendon of the fibularis (peroneus) longus. The head is large; on its plantar surface are 2 grooved facets, on which glide sesamoid bones; the facets are separated by a smooth elevation.

Second metatarsal bone The second metatarsal bone is the longest of the metatarsal bones, as it extends proximally the most, articulating with the recessed middle cuneiform. Its base is broad above, narrow and rough below. It presents 4 articular surfaces: one behind, of a triangular form, for articulation with the second cuneiform; one at the upper part of its medial surface, for articulation with the first cuneiform; and 2 on its lateral surface, an upper and lower, separated by a rough nonarticular interval. Each of these lateral articular surfaces is divided into 2 by a vertical ridge; the 2 anterior facets articulate with the third metatarsal; the 2 posterior (sometimes continuous) with the third cuneiform. A fifth facet is occasionally present for articulation with the first metatarsal; it is oval in shape and situated on the medial side of the body near the base.

Third metatarsal bone The third metatarsal bone articulates proximally, by means of a triangular smooth surface, with the third cuneiform; medially, by 2 facets, with the second metatarsal; and laterally, by a single facet, with the fourth metatarsal. This last facet is situated at the dorsal angle of the base. Fourth metatarsal bone The fourth metatarsal bone is smaller than the preceding metatarsal bones; its base presents an oblique quadrilateral surface for articulation with the cuboid; a smooth facet on the medial side, divided by a ridge into an anterior portion for articulation with the third metatarsal, and a posterior portion for articulation with the third cuneiform. On the lateral side, a single facet, for articulation with the fifth metatarsal, can be found. Fifth metatarsal bone The fifth metatarsal bone is recognized by a rough eminence, the tuberosity, on the lateral side of its base. The base articulates behind, by a triangular surface cut obliquely in a transverse direction, with the cuboid, and medially, with the fourth metatarsal.

The tendon of the fibularis (peroneus) tertius inserts on the medial part of its dorsal surface. The fibularis (peroneus) brevis inserts on the dorsal surface of the tuberosity. A strong band of the plantar aponeurosis connects the projecting part of the tuberosity with the lateral process of the tuberosity of the calcaneus. The plantar surface of the base is grooved for the tendon of the abductor digiti (minimi) quinti and gives origin to the flexor digiti minimi (quinti) brevis. Metatarsal articulations The base of each metatarsal bone articulates with one or more of the tarsal bones, and the head articulates with one of the first row of phalanges. The first metatarsal articulates with the first cuneiform, the second with all 3 cuneiforms, the third with the third cuneiform, the fourth with the third cuneiform and the cuboid, and the fifth with the cuboid.

Previous View Media Gallery Proximal phalanges The body of each proximal phalanx is similar to the metatarsals in being convex above and concave below. The base is concave for articulation with the respective metatarsal, and the head presents a trochlear surface for articulation with the second phalanx. Middle phalanges The middle phalanges are smaller than the proximal ones but larger than the distal phalanges; the features at the base and head are similar to the proximal phalanges. Distal phalanges The distal phalanges are flattened from above downward; each presents a broad base for articulation with the corresponding bone of the second row and an expanded distal tip for the support of the nail and end of the toe. Sesamoids of the foot Galen apparently first coined the term sesamoid because of the resemblance of these small rounded bones to the sesame seed. [ 7 ] The location of the sesamoids in the foot is constant, but the frequency of occurrence may vary. [ 8 ] The sesamoids give a mechanical advantage to the musculotendinous unit in which they are located and reduce friction and pressure in the nearby joint.

The sesamoids may be totally or partially contained within the tendinous structure, and they may ossify or remain cartilaginous or partially ossify with a fibrocartilaginous interface between the ossified fragments. This variability in ossification might explain the radiographic absence or presence of various sesamoid bones, as well as the incidence of bipartism of sesamoids. Previous Superior view of the acetabulum pedis. Medial view of the talus and calcaneal bones. Lateral view of talus and calcaneal bones. Anterior view of the talus and calcaneus bones. Lateral view of the calcaneus and cuboid bones. Anterior surface of the calcaneus bone. Lateral surface of the calcaneus bone. Medial surface of the calcaneus bone. Superior surface of the calcaneus bone. Superior surface of the talus bone. Medial surface of the talus bone. Lateral surface of the talus bone. Posterior surface of the talus bone. Inferior surface of the talus bone. Superior view of the talus and navicular bones. Posterior surface of the navicular bone.

Dorsal surface of the navicular bone. of 23 Calcaneus Bone Anatomy, Definition & Function | Body Maps Your message has been sent. OK We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Close Calcaneus Located within the foot, the calcaneus is also known as the heel bone. It is situated in the back of the foot, just below the talus, tibia, and fibula bones of the lower leg. Of all of the bones in the foot, the heel bone is the largest. The calcaneus has a unique design and structure. At the front, the heel bone features many curves to accommodate the talus and the many different tarsal bones, which lead to the metatarsals and phalanges that make up the front of the foot and toes. The back of the heel bone is not as complex, featuring a tuberosity and a medial process — landmark areas of the bone where muscles attach. The calcaneus provides insertion points for the abductor hallucis and the abductor digiti minimi muscles.

At the back of the heel, the Achilles tendon inserts into the rough area located on the superior (upper) side. This fibrous connective tissue, as well as other ligaments and muscles, is necessary for standing, walking, and running. As such, a broken or fractured calcaneus will make these movements difficult. Foot Bones | Anatomy of Foot in the Human Body| Learn Bones distal phalanges (5 × 2) Tarsal / Ankle Bones The tarsal bones are a series of bones that make up the region known as the tarsus, or more commonly known as the ankle. Calcaneus (Heel Bone) Click to Enlarge The calcaneus bone, also known as the heel bone, is the largest bone of the tarsal or ankle region. The calcaneus also constitutes the region known as the heel. This bone is very important in movement of the foot and support of the body. Additionally, the calcaneus consists of important structures, such as the Achilles tendon, tarsal sinus, and the tuber calcanei.

Talus Click to Enlarge The talus bone, also known as the astragalus, is an irregularly shaped bone of the tarsal or ankle region. This is the second largest of the ankle bones and forms part of the ankle joint. The talus functions in allowing motion of the foot and transfers the body's weight to the foot. Additionally, the talus is divided into three regions: the head, neck, and body. Cuboid Click to Enlarge The cuboid bone is one of the several bones found in the tarsal or ankle region. This bone is found in each ankle and thus contributes two bones to the human skeleton. The function of the cuboid is support of the body's weight, locomotion, and maintaining lateral foot stability. Additionally, the cuboid bone forms part of many joints in the foot, such as the tarsometatarsal and calcaneocuboid joints. Navicular Click to Enlarge The navicular bone is one of the bones of the tarsal or ankle region. This bone is found in each ankle and contributes two bones to the human body skeleton. The navicular is a relatively small bone that plays a function in locomotion and body support.

It touches five other bones: the three cuneiform bones, the talus bone, and the cuboid bone. Additionally, the navicular resembles a boat due to its concavity. Lateral Cuneiform Click to Enlarge The lateral cuneiform bones are two bones of the tarsal or ankle regions in the human skeleton. The lateral cuneiform is a wedge shaped bone located in between the intermediate cuneiform and cuboid bones. Like the other tarsal bones, the lateral cuneiform plays a role in motion and support. Furthermore, the lateral cuneiform is also known as the third cuneiform or external cuneiform. Intermediate Cuneiform Click to Enlarge The intermediate cuneiform bone is located in the ankle region of the skeleton. This bone is found in each tarsus / ankle and thus contributes two bones to the human body skeleton. The intermediate cuneiform is wedge shaped and is also known as the second cuneiform bone or middle cuneiform bone. The bone plays a role in movement and support of the body.

Medial Cuneiform Click to Enlarge The medial cuneiform, also known as the first cuneiform, is a bone found in the tarsus or ankle region. The medial cuneiform is found in each ankle and thus two medial cuneiform bones are found in the entire human skeleton. Like other tarsal bones, this bone plays a role in motion and support of the body. Additionally, the medial cuneiform touches four other bones: the intermediate cuneiform bone, the navicular, and two metatarsal bones. Metatarsal Bones Metatarsal Bones Each foot consists of five metacarpal bones and thus the entire human skeleton consists of ten metatarsal bones. The metatarsal bones are located between the tarsus and the phalanges (toes). The metatarsal bones' primary functions include foot motion, body support, and providing the shape of the foot. (Diagram of the metatarsal bones is shown at the top of the page). Phalanges The Phalanges consist of three sections. The proximal phalanges, the intermediate phalanges, and the distal phalanges. Collectively, these bones make up the structure known as the toes.

(Diagram of the phalanges is shown at the top of the page). Proximal Phalanges The proximal phalanges are found at the base of the toes, closest to the tarsus. These bones are longer than the play an important role in movement of the foot. Intermediate Phalanges The intermediate phalanges are found in between the proximal phalanges and distal phalanges. There are four intermediate phalanges found on each foot, the only toes that lacks the intermediate phalanges are the thumbs. Like the distal phalanges, the intermediate phalanges plays an important role in motion of the foot. Distal Phalanges The distal phalanges are a series of bones found at the tip of the foot, following the intermediate phalanges. The distal phalanges consists of five bones per foot and thus contribute a total of ten bones to the human skeleton. These bones play an important role in movement of the foot. The anatomy of Foot Bones. Foot & Ankle Anatomy - Foot Anatomy - HealthCommunities.com Foot & Ankle Anatomy Print Anatomy of the Foot and Ankle The human foot combines mechanical complexity and structural strength.

The ankle serves as foundation, shock absorber and propulsion engine. The foot can sustain enormous pressure (several tons over the course of a one-mile run) and provides flexibility and resiliency. The foot and ankle contain: 26 bones (One-quarter of the bones in the human body are in the feet.); 33 joints; more than 100 muscles, tendons and ligaments (Tendons are fibrous tissues that connect muscles to bones and ligaments are fibrous tissues that connect bones to other bones.); and a network of blood vessels, nerves, skin, and soft tissue. These components work together to provide the body with support, balance, and mobility. A structural flaw or malfunction in any one part can result in the development of problems elsewhere in the body (such as back pain ). Abnormalities in other parts of the body can lead to problems in the feet. Parts of the Foot Structurally, the foot has three main parts: the forefoot, the midfoot, and the hindfoot. Top View of Foot Bones Side View of Foot Bones Click on the images to view a larger version.

The forefoot is composed of the five toes (called phalanges) and their connecting long bones (metatarsals). Each toe (phalanx) is made up of several small bones. The big toe (also known as the hallux) has two phalanx bones—distal and proximal. It has one joint, called the interphalangeal joint. The big toe articulates with the head of the first metatarsal and is called the first metatarsophalangeal joint (MTPJ for short). Underneath the first metatarsal head are two tiny, round bones called sesamoids. The other four toes each have three bones and two joints. The phalanges are connected to the metatarsals by five metatarsal phalangeal joints at the ball of the foot. The forefoot bears half the body's weight and balances pressure on the ball of the foot. The midfoot has five irregularly shaped tarsal bones, forms the foot's arch, and serves as a shock absorber. The bones of the midfoot are connected to the forefoot and the hindfoot by muscles and the plantar fascia (arch ligament).

The hindfoot is composed of three joints and links the midfoot to the ankle (talus). The top of the talus is connected to the two long bones of the lower leg (tibia and fibula), forming a hinge that allows the foot to move up and down. The heel bone (calcaneus) is the largest bone in the foot. It joins the talus to form the subtalar joint. The bottom of the heel bone is cushioned by a layer of fat. Publication Review By: John J. Swierzewski, D.P.M. Published: 30 Dec 1999 Achilles Tendon (Human Anatomy): Picture, Definition, Injuries, Pain, and More Next The Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon is also called the calcaneal tendon. The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. Small sacs of fluid called bursae cushion the Achilles tendon at the heel.

The Achilles tendon is the largest and strongest tendon in the body. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it. Achilles Tendon Conditions Achilles tendon tear : Tears of the Achilles tendon can be tiny (microtears), or large, causing pain, swelling, and impaired movement. They may occur suddenly during activity, or gradually over time. Achilles tendon rupture : A complete rupture of the Achilles tendon may make a "pop" sound, followed by pain and swelling of the lower leg. Treating an Achilles tendon rupture requires surgery or long-term immobilization of the ankle. Achilles tendinitis (tendonitis): Frequent activity (running or walking) can gradually inflame the end of the Achilles tendon, causing pain and stiffness at the back of the heel. Rest, ice, and stretching may speed healing, which can take weeks.

Achilles peritendonitis: Similar to Achilles tendonitis, but inflammation and pain occur in the tissue surrounding the tendon, often two or more inches above the heel. Achilles tendinosis: Gradual thickening of the Achilles tendon without apparent inflammation, due to aging or overuse. Despite the thickening, the tendon is weakened and prone to further injury or rupture. Achilles tendinopathy : A general term for tendinitis or tendinosis affecting the Achilles tendon. Achilles or heel (calcaneal) bursitis : Low-riding shoes can irritate the bursa, a sac of fluid cushioning the Achilles tendon at the heel. Pain in the back of the heel, worse with shoes on, is the common symptom. Continued Achilles Tendon Tests Physical examination : To look for Achilles tendon problems, an examiner checks for pain, swelling, warmth, thickening, or discoloration around the heel and leg. A knot on the back of the leg may be present with Achilles tendon rupture. Most cases of tendinopathy without a rupture can be diagnosed by physical exam and often do not need further testing.

Thompson test : Lying prone (on one’s stomach) or while kneeling on a chair, an examiner squeezes the calf. The end of the foot should move down in response; if it does not, an Achilles tendon rupture may be present. Knee flexion (Matles) test: A person lies face down and bends the knee slowly to a right angle. During this movement, the toe end of the foot should point away from the leg slightly; if it doesn't, an Achilles tendon rupture may be present. Magnetic resonance imaging ( MRI scan ): An MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the ankle and leg. An MRI scan is the best test to diagnose an Achilles tendon rupture or other problems but it may not always detect tendinopathy. Achilles tendon ultrasound : A probe on the skin reflects high-frequency sound waves off the ankle, producing images of the Achilles tendon. Ultrasound can often diagnose an Achilles tendon rupture. Computed tomography ( CT scan ): A CT scanner takes multiple X-rays, and a computer constructs detailed images of the ankle and leg. An MRI scan is superior to a CT scan in diagnosing Achilles tendon problems.

X-ray film : A plain X-ray film may identify problems with the bones or ankle joint, but it cannot diagnose Achilles tendon problems. Continued Achilles Tendon Treatments RICE therapy : Most Achilles tendon injuries can be treated with RICE: Rest, Ice, Compression with a sports bandage, and Elevation. Pain relievers : Over-the-counter medicines like acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) can lessen the pain of most Achilles tendon problems. For more severe pain, prescription pain relievers may be necessary. Heat : Alternating ice and heat therapy may improve the pain of bursitis near the Achilles tendon. Footwear: Wearing shoes with good support that are right for your feet may help avoid continual injury to the Achilles tendon. Custom-made orthotics, heel lifts, and certain splints and braces are sometimes helpful. Physical Therapy: Although modifying or decreasing activity is important, particular stretches and exercises may be helpful to rehabilitate tendon problems, especially when they are persistent. Immobilization : Many moderate to severe Achilles tendon conditions require immobilization of the ankle joint. This may require wearing a special boot or a leg cast for several weeks.

Achilles tendon surgery : Surgery can often reattach a ruptured Achilles tendon. Following surgery, immobilization of the ankle is necessary for several weeks. WebMD Image Collection Reviewed by Varnada Karriem-Norwood, MD on November 15, 2014 Sources

Question: Where in the human body would you find the bone called the 'Calcaneus'?
Answer: HEEL