[Fatigue fracture of the calcaneus]

Formerly, stress-fractures of the metatarsus were the most common stress fractures. But over the last years, tibial and calcaneal localizations have dominated. The diagnosis of a calcaneal stress fracture is usually easy, provided the possibility is remembered. The symptoms are indeed vague, and radiological alterations are often not seen during the first 2 months. Sclerosis (callus formation) is the first finding on roentgenograms. A periosteal reaction like on tabular bone is never seen. Signs of a stress fracture are first seen on bone-scan, but other nonstress-related bone abnormalities which have not manifested any radiographic changes such as early osteomyelitis, fibrous dysplasia, bone tumor, etc. have to be excluded. The treatment is simple. Vigorous activities are stopped for 6 weeks, soft heel pads are given, partial weight-bearing can be helpful for some days. Plaster is usually neither necessary nor useful.