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Calcaneal fractures can be extra-articular fracture or intra-articular fractures. However, extra-articular calcaneal fractures are the most common type. 跟骨骨折分关节外骨折和关节内骨折， 而关节外跟骨骨折是最常见的类型。
关节外关节骨折可以是前部骨折。这些骨折是由过度跖屈和反转引起的。它们通常被遗漏和/或误诊为踝关节扭伤。当确诊后，通常采取保守治疗，有大的移位碎片则需要手术。 One important extra-articular fracture type is the tuberosity avulsion fracture. This type of injury is usually due to sudden dorsiflexion of the gastrocnemius and soleus muscles, which pull the Achilles tendon upwards, causing an avulsion fracture of the calcaneus. The avulsion fracture may cause skin compromise at the back of the heel. Some predisposing factors of avulsion fractures include diabetes and osteoporosis. Additionally, there are several type of avulsion fractures. These include type I, the “sleeve” type tuberosity fracture, type II, also knowns as the “beak” type avulsion fracture, or type III, an infrabursal fracture. The last type of avulsion fracture is rare. 一种重要的关节外骨折类型是结节性撕脱骨折。这种损伤通常是由于足突然背屈，腓肠肌和比目鱼肌使跟腱向上拉，导致跟骨的撕脱性骨折。撕脱性骨折可能导致足跟后部的皮肤受损。撕脱性骨折的一些诱发因素包括糖尿病和骨质疏松症。另外，有几种类型的撕脱骨折。这些包括I型，“套管”型结节性骨折，II型，也称为“喙”型撕脱性骨折，III型，（外表面纤维）引起的囊下骨折。最后一种类型的撕脱性骨折是罕见的。 Another type of extra-articular calcaneal fracture is the tuberosity body fracture. This type results from an axial body load injury. A CT scan may be needed to rule out an intra-articular extension injury. 另一种类型的关节外跟骨骨折是结节性骨折。这种类型是由轴向载荷损伤引起的。可能需要CT扫描来排除关节内延伸损伤。 The sustentacular type of calcaneal fracture results from heel loading accompanied by forced inversion of the foot. The flexor hallucis longus tendon is then lodged underneath the sustentaculum. Surgery is rarely needed for this type of fracture.Most calcaneal fractures are closed injuries that are treated non-operatively, but can be treated with surgery when the fracture is intra-articular and displaced. The surgery is usually done after improvement of the soft tissue condition. Avulsion fractures are different- they require urgent care for reduction and fixation of the fracture. This will eliminate the risk of skin complications and restore the function of the Achilles tendon. 跟骨支撑型骨折是由脚跟负重和足部强迫倒置造成的，拇屈肌长肌腱则位于支撑带下方。这种类型的骨折很少需要手术，大多数闭合性跟骨骨折采用非手术治疗，但是关节内骨折且有移位时需要手术治疗。手术通常在改善软组织状况后进行。撕脱骨折是不同的-他们需要紧急复位和固定，这将消除皮肤并发症的风险并恢复跟腱的功能。 The calcaneal stress fracture is another type of extra-articular fracture. This type of fracture is typically felt deep in the bone and produces a vague complaint of heel pain. Stress fractures of the calcaneus are usually seen in athletes who are over-training, using improper footwear, or those who have mechanical abnormalities. The pain from a stress fracture will appear suddenly, but remain constant. Additionally, the pain and swelling may be felt and seen no both sides of the heel. The pain associated with a stress fracture can usually be reproduced be squeezing the heel from both sides. However, this pain can be confused with plantar fasciitis, but the pain from plantar fasciitis is most severe in the morning and when first standing. 跟骨应力性骨折是另一种类型的关节外骨折。这种类型的骨折通常感觉到脚后跟不明确的疼痛。跟骨应力性骨折常见于训练过度、穿鞋不当或机械异常的运动员。应力性骨折的疼痛会突然出现，且持续。另外，可以感觉到疼痛和肿胀，但看不到脚跟两侧的异常。通常可以通过从两侧挤压脚跟来再现与应力性骨折相关的疼痛。然而，这种疼痛可能与足底筋膜炎相混淆，但足底筋膜炎的疼痛在早晨和首次站立时最为严重。 Imaging tests may be helpful to confirm diagnosis of a stress fracture. However, the fracture may be difficult to be seen on x-rays until it starts to heal, and therefore early x-rays are usually negative. X-rays at 4–6 weeks will show the fracture line on the posterior aspect of the calcaneus as a radiodense vertical line. If the clinical picture is not clear, MRI is helpful in the diagnosis of a stress fracture. 影像学检查有助于确定应力性骨折的诊断。然而，骨折在开始愈合之前很难用x射线看到，因此早期x射线通常是阴性的。4-6周的x线显示跟骨后侧骨折线为放射状致密垂直线。如果临床图像不清楚，MRI有助于诊断应力性骨折。 The treatment for a calcaneal stress fracture is usually conservative in nature. The patient will need to avoid activities such as running or jumping, use proper footwear to cushion the heel (orthotics), and/or be non-weight bearing for 6 weeks utilizing a boot or cast. 跟骨应力性骨折通常采用保守治疗。患者需要避免跑步或跳跃等活动，使用合适的鞋垫鞋跟(矫正器)，或使用靴子或石膏，在6周内不负重。 足的解剖（视频讲解） 跟骨骨折（视频讲解）
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