An 18-year-old female presented with pain in her left foot after jumping from a first story window and landing on a pool deck with her full weight on her left foot. On examination, she had bruising and tenderness to palpation on the plantar surface and calcaneus of her left foot and could only bear weight on her toes. She was given instructions for strict elevation, immobilization with a posterior splint, non-weight bearing, follow up with orthopedics, and analgesia for a suspected calcaneus fracture from the fall.

2.  18 YOF pw pain in left foot.
Pain began after she
jumped from a first story
window. Pt landed on pool
deck, instead of pool with
full weight on her left foot.
Pain is located throughout
her whole foot and ankle.
Can walk but bears weight
on her toes only. Denies
pain in left knee and
contralateral LE.
 T 97.6 P 120 BP 126/84 O2 97%
 Gen: Severe discomfort 2/2




pain, anxious, crying.
CV: Tachycardic, no m/r/g
Pulm: CTAB.
MSK: L foot w/o bony
abnormalities. NV intact.
Bruising noted along plantar
surface. TTP at calcaneus and
mid plantar surface. No TTP at
maleoli, proximal fibula, or
tibial plateau.
Back: No bony abnormalities of
CS, TS or LS.

5.  Strict Elevation
 Immobilize – Posterior Splint, well padded
 Non-weight bearing
 Immediate follow up with Orthopedics.
 Analgesia

6.  Strict Elevation
 Immobilize – Posterior Splint, well padded
 Strict Non-weight bearing
 Close follow up with Orthopedics.
 Analgesia

7.  These injuries require tremendous force and are often
associated with another injuries including fractures
(LS, contralateral leg)
 Gissane Angle and Boehler’s Angle help with
diagnosis.
 AKA Lover’s Fracture or Don Juan Fracture
 Management is controversial.

8. Bohler's angle is the compliment of the
angle at the apex of the posterior facet.
To construct Bohler's angle a line is
drawn from the superior aspect of the
anterior process to the superior aspect of
the posterior facet. A second line is
drawn from the superior aspect of the
posterior facet to the superior most
point of the calcaneal tuberosity.
Bohler's angle is the angle formed
between these two lines. A normal
Bohler's angle is approximately 25 to 40
degrees. It should be obvious that this
angle decreases as the height of the
calcaneus is lost; as this angle shrinks as
the height of the posterior facet
decreases

9. Angle is formed by the
intersection of the
downward slope of the
posterior facet, with the
upward slope going
anterior. This is normally
approximately 100
degrees.
Medially is the
sustentaculum tali.

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O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski,
David M. Cline. McGraw-Hill Professional Publishing: 2010.
Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.
Current concepts review: intra-articular fractures of the calcaneus.
Epstein N, Chandran S, Chou L. Foot Ankle Int. 2012 Jan;33(1):7986.
Complications associated with open calcaneus fractures. Wiersema
B, Brokaw D, Weber T, Psaradellis T, Panero C, Weber C,
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