X-ray of calcaneal fractures

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Author: Mikael Häggström [notes 1]


Projectional radiography ("X-ray") is usually the initial modality for suspected calcaneal fracture.


Even if there's an initial obvious fracture, evaluate:

  • Bone contours for disruptions
  • Bone areas for unusual lines that are either hypoattenuating (in case of separation) or hyperattenuating (in case of compression)
Bohler's angle[1]
Gissane's angle

On lateral radiographs, two angles are helpful in indicating a calcaneal fracture even when the fracture is not clearly visible:

  • Bohler's angle, or the "Tuber Angle" is formed by the intersection of
  • A line from the highest point of the posterior articular facet to the highest point of the posterior tuberosity.
  • A line tangential to the superior edge of the tuberosity.[1]

Bohler's angle is normally 25° to 40°.[1] A decreased angle is indicative of a calcaneal fracture.

  • The Angle of Gissane, also called "Critical Angle", is the angle formed by the downward and upward slopes of the calcaneal superior surface. An angle of Gissane of more than 130° suggests a fracture of the posterior subtalar joint surface.

Further evaluation

A CT scan of calcaneal fracture is currently the imaging study of choice for evaluating calcaneal injury.[2]


General notes on fracture reporting

See also


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.


  1. 1.0 1.1 1.2 Page 562 in: Mark D. Miller; Stephen R. Thompson (2015). Miller's Review of Orthopaedics (7th ed.). Elsevier Health Sciences. ISBN 9780323390422. 
  2. Badillo, Kenneth; Pacheco, Jose A.; Padua, Samuel O.; Gomez, Angel A.; Colon, Edgar; Vidal, Jorge A. (2011). "Multidetector CT Evaluation of Calcaneal Fractures ". RadioGraphics 31 (1): 81–92. doi:10.1148/rg.311105036. PMID 21257934.