Neuropathic avulsion fracture of the calcaneum

A 45-year-old woman with type 1 diabetes of 29 years' duration, developed a red, hot swollen foot 2 weeks after a fall.

Acute Charcot's osteoarthropathy of the mid-foot was diagnosed and she wore a total-contact cast for 7 months. When the foot had settled down with resolution of redness, warmth and swelling she was given a removable cast and advised to limit her walking to a few steps a day. Christmas was coming, and she went out to do her Christmas present shopping without her cast. Next morning the foot was hot, swollen and bruised and she came to the clinic. X-ray revealed that the entire posterior pillar of the calcaneum had been avulsed from the main body of the bone and was dangling from the Achilles tendon.

She was conservatively treated in a plaster cast applied to a plantar flexed foot, and subsequently in a bespoke boot: the foot remained ulcer free and the fracture healed.

Key points

• Rapid mobilization after Charcot's osteoarthropathy can lead to relapse

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