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Portrait of Calcaneus

Anatomy · Bones

Calcaneus

The heel bone — the largest bone of the foot

Foot · hindfoot · tarsal bones

The calcaneus, or heel bone, is the largest and strongest bone of the foot. It lies below the talus at the back of the foot, projects behind the tibia and fibula, and takes the first impact in walking. The Achilles tendon inserts on its rear surface, making it a short lever for the calf muscles, and a shelf on its inner face, the sustentaculum tali, supports the talus.

How to spot them

  • ▸Large, roughly box-shaped bone at the back of the foot, forming the heel and projecting backwards beyond the ankle
  • ▸Rough, rounded posterior surface (calcaneal tuberosity) where the Achilles tendon attaches; the plantar fascia attaches to its underside
  • ▸A shelf on its inner face (sustentaculum tali) supports the talus and has a groove beneath for the flexor hallucis longus tendon
  • ▸Articulates with the talus above by three facets and with the cuboid in front by a saddle-shaped surface

What to know

The largest bone of the foot, forming the heel, which takes the first impact of each stride

Calcaneus — the heel bone.

The tendon of the calf muscles inserts on its rear surface, making it a short lever for lifting the body onto the toes

Calcaneus — the Achilles (calcaneal) tendon.

A horizontal shelf on its inner face 'supports the talus', and a tendon of the big toe runs in a groove beneath it

Calcaneus — the sustentaculum tali, with the groove for flexor hallucis longus.

The most commonly fractured bone of the tarsus, classically after a fall from a height, and nicknamed for lovers escaping through a window

Calcaneus — 'lover's' or 'Don Juan' fracture.

On a side-on X-ray, an angle between two lines through its upper surface, normally about 20 to 40 degrees, flattens after a crush fracture

Calcaneus — Böhler's angle.

A bony spur growing from the underside near the attachment of a fibrous band of the sole is associated with 'policeman's heel'

Calcaneus — the calcaneal spur, in plantar fasciitis.

Inflammation of its growth plate causes heel pain in active children aged about 8 to 14, and is named after an American orthopaedic surgeon, Sever

Calcaneus — Sever's disease (calcaneal apophysitis).

It articulates with the ankle bone above by three facets and with the cuboid in front by a saddle-shaped surface

Calcaneus — the subtalar and calcaneocuboid joints.

Key ideas

  • Body weight passes from the tibia to the talus and then to the calcaneus, which rests on the ground; the calcaneus is the posterior pillar of the longitudinal arches of the foot.
  • Its Achilles tendon insertion gives the calf muscles a short lever: the bone projects backwards to increase the mechanical advantage.
  • It is made mostly of spongy (trabecular) bone with a thin cortex, which is why a fall from height crushes it and why it is used in heel ultrasound for bone density.

Quick-fire facts

  • •It is the largest tarsal bone and the largest bone of the foot; it forms the heel.
  • •It is the most commonly fractured tarsal bone, accounting for about 60% of tarsal fractures and roughly 2% of all fractures (Kenhub); most (70–75%) are intra-articular.
  • •The 'lover's' (or 'Casanova' / 'Don Juan') fracture is a calcaneal fracture from a fall from a height, sometimes bilateral; when both are broken the spine should be checked.
  • •Böhler's angle is normally about 20–40 degrees and is reduced in a depressed intra-articular fracture.
  • •The plantar fascia attaches to the medial process of the calcaneal tuberosity; plantar fasciitis is the commonest cause of heel pain.
  • •Sever's disease, described by James Warren Sever in 1912, is calcaneal apophysitis in children aged about 8–14.
  • •Haglund's deformity ('pump bump') is a prominence at the back of the calcaneus that rubs against shoes.
  • •It ossifies before birth (from a centre appearing in fetal life), with a separate growth plate at the back that fuses in the mid-teens; that plate is the site of Sever's disease.
  • •The Latin calcaneus derives from calx, the heel.
  • •The Achilles tendon, the thickest and strongest tendon in the body, is named for the Greek hero killed by an arrow to the heel.

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