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<div class="editorbox"> '''Original Editor '''- [[User:Lucinda hampton|Lucinda hamptom]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


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'''Original Editor'''
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== Introduction  ==
== Introduction  ==
[[File:Calcaneus animation01.gif|right|frameless|350x350px]]
[[File:Calcaneus animation01.gif|right|frameless|350x350px]]
The calcaneus bone is one of the 7 articulating [[bone]]<nowiki/>s that make up the tarsus. The calcaneus is located in the hindfoot with the talus and is the largest bone of the foot.  
The calcaneus is one of the 7 articulating [[bone]]<nowiki/>s that make up the tarsus. The calcaneus is located in the hindfoot with the [[talus]] and is the largest bone of the foot<ref name=":2">Palastanga N, Field D, Soames R. Anatomy and human movement. 4th edition. Oxford. Butterworth-Heinemann; 2002. p242.</ref>.
* It is commonly referred to as the heel. 
* It is commonly referred to as the heel. 
* Numerous [[ligament]]<nowiki/>s and [[Muscle|muscles]] attach to the calcaneus and help with its role in human bipedal biomechanics<ref name=":0">Gupton M, Terreberry RR. [https://www.statpearls.com/kb/viewarticle/18764 Anatomy, bony pelvis and lower limb, calacaneous.] InStatPearls [Internet] 2018 Dec 6. StatPearls Publishing. Available from:https://www.statpearls.com/kb/viewarticle/18764 (last accessed 12.3.2020)</ref>
* Numerous [[ligament]]<nowiki/>s and [[Muscle|muscles]] attach to the calcaneus and help with its role in human bipedal biomechanics<ref name=":0">Gupton M, Terreberry RR. [https://www.statpearls.com/kb/viewarticle/18764 Anatomy, bony pelvis and lower limb, calacaneous.] InStatPearls [Internet] 2018 Dec 6. StatPearls Publishing. Available from:https://www.statpearls.com/kb/viewarticle/18764 (last accessed 12.3.2020)</ref>
* It articulates with the talus superiorly and the cuboid anteriorly and shares a joint space with the talonavicular joint, appropriately called the talocalcaneonavicular joint.  
* It articulates with the [[talus]] superiorly and the [[cuboid]] anteriorly and shares a joint space with the talocalcaneonavicular joint.
* The calcaneus transfers most of the body weight from the lower limb to the ground.<ref name=":1">[https://radiopaedia.org/articles/calcaneus?lang=gb Calcaneus] Radiopedia Available from:https://radiopaedia.org/articles/calcaneus?lang=gb (last accessed 12.3.2020)</ref>
* The calcaneus transfers most of the body weight from the lower limb to the ground.<ref name=":1">Radiopedia. Calcaneus. Available from:https://radiopaedia.org/articles/calcaneus?lang=gb (accessed 12/03/2020).</ref>


== Structure  ==
== Structure  ==
[[File:Calcaneus.jpg|border|right|frameless|500x500px]]
[[File:Calcaneus.jpg|border|right|frameless|601x601px]]
The calcaneus is an irregular, roughly box-shaped bone sitting below the [[talus]]. Its long axis is orientated along the mid-line of the [[Foot Anatomy|foot]], however deviates lateral to the mid-line anteriorly. It projects posteriorly to form the core of the heel.
The calcaneus is an irregular, roughly box-shaped bone sitting below the [[talus]]. Its long axis is orientated along the mid-line of the [[Foot Anatomy|foot]], however, deviates lateral to the mid-line anteriorly. It projects posteriorly to form the core of the heel<ref name=":2" />.


The posterior part of the calcaneus is circular, with three facets (superior, middle and inferior). 
The posterior part of the calcaneus is circular, with three facets (superior, middle and inferior): 
# The superior facet is separated from the calcaneal tendon by the retrocalcaneal bursa.  
# The superior facet is separated from the calcaneal tendon by the retrocalcaneal bursa.  
# The middle facet provides the attachment site for the calcaneal tendon (Achilles tendon).  
# The middle facet provides the attachment site for the calcaneal tendon ([[Achilles Tendon|Achilles tendon]]).  
# The inferior facet curves anteriorly and is continuous with calcaneal tuberosity on the plantar surface.  
# The inferior facet curves anteriorly and is continuous with calcaneal tuberosity on the plantar surface.  
The plantar surface of the calcaneal tuberosity projects forward on the plantar surface as a medial (larger) and lateral (smaller) process and at its most anterior projection is the calcaneal tubercle, where the short plantar ligament attaches.


On the lateral aspect of the calcaneus is the [[Peroneal Tendinopathy|peroneal]] tubercle, anterior to the middle of the surface, where the tendons of the fibularis brevis and longus muscles pass above and below respectively.


Protruding anteromedially from upper margin of the medial surface is the sustentaculum tali which supports the more posterior part of the head of the talus.  
 
The plantar surface of the calcaneal tuberosity projects forward on the plantar surface as a medial (larger) and lateral (smaller) process and at its most anterior projection is the calcaneal tubercle, where the short plantar ligament attaches<ref name=":2" />.
 
On the lateral aspect of the calcaneus is the peroneal tubercle, anterior to the middle of the surface, where the tendons of the [[Peroneus Brevis|fibularis brevis]] and [[Peroneus (Fibularis) Longus Muscle|longus]] muscles pass above and below respectively.
 
Protruding anteromedially from upper margin of the medial surface is the sustentaculum tali which supports the more posterior part of the head of the [[talus]].  


At its inferior aspect is a groove accommodating the [[flexor hallucis longus]] tendon.  
At its inferior aspect is a groove accommodating the [[flexor hallucis longus]] tendon.  


Superiorly is the middle talar articular facet for the corresponding middle facet of the head of talus as part of the subtalar joint.
Superiorly is the middle talar articular facet for the corresponding middle facet of the head of [[talus]] as part of the subtalar joint.


The anterior and posterior facets of the talocalcaneal joint are on the superior surface of the calcaneus. The anterior facet is small and the posterior facet is large. Between these two facets runs a fairly deep sulcus, the calcaneal sulcus, which together with the opposing talar sulcus forms the tarsal sinus.
The anterior and posterior facets of the talocalcaneal joint are on the superior surface of the calcaneus. The anterior facet is small and the posterior facet is large. Between these two facets runs a fairly deep sulcus, the calcaneal sulcus, which together with the opposing talar sulcus forms the tarsal sinus.
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== Articulations  ==
== Articulations  ==
* Superiorly, the calcaneus articulates with the talus at the talocalcaneal joint, (subtalar joint), making contact at anterior, middle and posterior facets.
* Superiorly, the calcaneus articulates with the [[talus]] at the [[Subtalar Joint|subtalar joint]], making contact at anterior, middle and posterior facets<ref name=":2" />.
* The anterior part of the talocalcaneal joint and the talonavicular joint are collectively known as the talocalcaneonavicular joint, and may share the same joint space.
* The anterior part of the talocalcaneal joint and the talonavicular joint are collectively known as the talocalcaneonavicular joint.
* Anteriorly, the calcaneus articulates with the cuboid (calcaneocuboid joint) bones.<ref name=":1" />
* Anteriorly, the calcaneus articulates with the cuboid, forming the calcaneocuboid joint.<ref name=":1" />


=== Attachments  ===
=== Attachments  ===
'''Muscular'''
 
*[[File:Achilles tendon.jpg|right|frameless|474x474px]][[Gastrocnemius|triceps surae]], i.e. gastrocnemius and soleus (insertion: middle facet of posterior surface of calcaneus through calcaneal/Achilles tendon)
==== Muscular ====
* abductor hallucis (origin: the medial process of calcaneal tuberosity)
[[File:Achilles tendon.jpg|right|frameless|474x474px]]
* flexor digitorum brevis (origin: the medial process of calcaneal tuberosity and plantar aponeurosis)
* [[Triceps Surae|Triceps surae]]: [[gastrocnemius]] and [[soleus]] inserts onto the middle facet of posterior surface of calcaneus through calcaneal/[[Achilles Tendon|Achilles tendon]]
* quadratus plantae (origin: the plantar surface of calcaneus)
* [[Abductor Hallucis|Abductor hallucis]]: originates from the medial process of calcaneal tuberosity.
* abductor digiti minimi (origin: the medial and lateral process of calcaneal tuberosity)
* [[Flexor Digitorum Brevis|Flexor digitorum brevis]]: originates from the medial process of calcaneal tuberosity and plantar aponeurosis.
* extensor digitorum brevis (origin: dorsolateral surface)
* [[Quadratus Plantae|Quadratus plantae]]:  originates the plantar surface of calcaneus
* extensor hallucis brevis (origin: dorsal surface, tarsal sinus)
* [[Abductor Digiti Minimi (Foot)|Abductor digiti minimi]]: originates from the medial and lateral process of calcaneal tuberosity
'''Ligamentous'''
* [[Extensor Digitorum Brevis|Extensor digitorum brevis]]: origin - dorsolateral surface
* lateral: lateral collateral ligament of the [[Ankle and Foot|ankle]] joint (calcaneofibular ligament)
* Extensor hallucis brevis: origin - dorsal surface, tarsal sinus
* inferior: short plantar ligament (at calcaneal tubercle), long plantar ligament (in front of calcaneal tuberosity), plantar aponeurosis (medial process of calcaneal tuberosity proximal to flexor digitorum brevis)
 
* superior: tarsal sinus ligaments, including:
==== Ligamentous ====
** cervical ligament
* Lateral: Lateral collateral/calcaneofibular ligament of the [[Ankle and Foot|ankle]]
** talocalcaneal interosseous ligament,
* Inferior: Short plantar ligament (at calcaneal tubercle), long plantar ligament (in front of calcaneal tuberosity), plantar aponeurosis (medial process of calcaneal tuberosity proximal to flexor digitorum brevis)
** lateral, intermediate, and medial roots of the inferior extensor retinaculum
* Superior: Tarsal sinus ligaments, including:
** bifurcate ligament
** Cervical ligament
* anterior: plantar calcaneonavicular ligament (anterior margin of the sustentaculum tali of the calcaneus)<ref name=":1" />
** Talocalcaneal interosseous ligament,
** Lateral, intermediate, and medial roots of the inferior extensor retinaculum
** Bifurcate ligament
* Anterior: plantar calcaneonavicular ligament (anterior margin of the sustentaculum tali of the calcaneus)<ref name=":1" />
 
== Blood Supply ==
* Medial side of the calcaneus is supplied by perforating branches from the posterior tibial artery.
* Lateral side of the calcaneus is supplied by the lateral calcaneal artery (can be a branch of the posterior tibial artery or the peroneal artery).
* Within the bone, there is a watershed area where the medial and lateral intra-osseous arteries anastomose in the midline.<ref>Razik A, Harris M, Trompeter A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862705/ Calcaneal fractures: Where are we now]?. Strategies in Trauma and Limb Reconstruction. 2018 Apr 1;13(1):1-1.</ref>
 
== Palpation ==
The posterior aspect of the calcaneus can be palpated directly inferior to the Achilles tendon.
 
Palpation is also possible around the inferior aspect of the calcaneus particularly the calcaneal tuberosity where the plantarfascia arises.
 
On the medial aspect the sustentaculum tali is possible to be palpated by palpating the medial malleolus and travelling directly inferior approximately 1-2cm.


== Related Pathology  ==
== Related Pathology  ==
*[[File:Heel-spur.jpg|right|frameless]][[Calcaneal Fractures|calcaneal fracture]]
*[[Calcaneal Fractures|Calcaneal fracture]]
* pseudotumour of the calcaneus
* Pseudo-tumour of the calcaneus
* talocalcaneal coalition
* Talocalcaneal coalition
* calcaneonavicular coalition
* Calcaneonavicular coalition
* [[Calcaneal Spurs|calcaneal spur]]<ref name=":1" />
* [[Calcaneal Spurs|Calcaneal/heel spur]]<ref name=":1" />[[File:Heel-spur.jpg|right|frameless]]
* [[Plantar Fasciitis|Plantar fasciitis]] (is a very prevalent condition that involves a noninflammatory structural breakdown of the connective tissue that makes up the plantar aponeurosis or fascia of the foot). Often found in association with heel spurs.<ref name=":0" />
* [[Plantar Fasciitis|Plantarfascia pain]]: a condition that involves a non-inflammatory structural breakdown of the connective tissue that makes up the plantar aponeurosis or fascia of the [[Foot Anatomy|foot]]. Often found in association with [[Calcaneal Spurs|heel spurs]].<ref name=":0" />
* A [[Haglund's deformity|Haglund]] deformity is a bony exostosis that extends from the posterior superior calcaneus where the Achilles attaches. The etiology of the condition is unknown but hypothesized causes are Achilles tendonitis, high arched feet, improper footwear, and other hereditary factors.<ref name=":0" /> 
* A [[Haglund's deformity|Haglund]] deformity is a bony exostosis that extends from the posterior superior calcaneus where the [[Achilles Tendon|Achilles]] attaches. The etiology of the condition is unknown but hypothesized causes are [[Achilles Tendinopathy|Achilles tendinopathy]], [[Pes cavus|high arched feet]] and other hereditary factors.<ref name=":0" /> 


== References  ==
== References  ==
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[[Category:Anatomy]]  
[[Category:Anatomy]]  
[[Category:Bones]]
[[Category:Bones]]
[[Category:Bone - Conditions]]
[[Category:Foot]]
[[Category:Foot - Anatomy]]
[[Category:Foot - Bones]]

Latest revision as of 11:05, 15 July 2022

Introduction[edit | edit source]

Calcaneus animation01.gif

The calcaneus is one of the 7 articulating bones that make up the tarsus. The calcaneus is located in the hindfoot with the talus and is the largest bone of the foot[1].

  • It is commonly referred to as the heel. 
  • Numerous ligaments and muscles attach to the calcaneus and help with its role in human bipedal biomechanics[2]
  • It articulates with the talus superiorly and the cuboid anteriorly and shares a joint space with the talocalcaneonavicular joint.
  • The calcaneus transfers most of the body weight from the lower limb to the ground.[3]

Structure[edit | edit source]

Calcaneus.jpg

The calcaneus is an irregular, roughly box-shaped bone sitting below the talus. Its long axis is orientated along the mid-line of the foot, however, deviates lateral to the mid-line anteriorly. It projects posteriorly to form the core of the heel[1].

The posterior part of the calcaneus is circular, with three facets (superior, middle and inferior): 

  1. The superior facet is separated from the calcaneal tendon by the retrocalcaneal bursa.
  2. The middle facet provides the attachment site for the calcaneal tendon (Achilles tendon).
  3. The inferior facet curves anteriorly and is continuous with calcaneal tuberosity on the plantar surface.


The plantar surface of the calcaneal tuberosity projects forward on the plantar surface as a medial (larger) and lateral (smaller) process and at its most anterior projection is the calcaneal tubercle, where the short plantar ligament attaches[1].

On the lateral aspect of the calcaneus is the peroneal tubercle, anterior to the middle of the surface, where the tendons of the fibularis brevis and longus muscles pass above and below respectively.

Protruding anteromedially from upper margin of the medial surface is the sustentaculum tali which supports the more posterior part of the head of the talus.

At its inferior aspect is a groove accommodating the flexor hallucis longus tendon.

Superiorly is the middle talar articular facet for the corresponding middle facet of the head of talus as part of the subtalar joint.

The anterior and posterior facets of the talocalcaneal joint are on the superior surface of the calcaneus. The anterior facet is small and the posterior facet is large. Between these two facets runs a fairly deep sulcus, the calcaneal sulcus, which together with the opposing talar sulcus forms the tarsal sinus.

The anterior surface has a convex articular facet for the cuboid bone[3].

Calcaneus animation03.gif

Articulations[edit | edit source]

  • Superiorly, the calcaneus articulates with the talus at the subtalar joint, making contact at anterior, middle and posterior facets[1].
  • The anterior part of the talocalcaneal joint and the talonavicular joint are collectively known as the talocalcaneonavicular joint.
  • Anteriorly, the calcaneus articulates with the cuboid, forming the calcaneocuboid joint.[3]

Attachments[edit | edit source]

Muscular[edit | edit source]

Achilles tendon.jpg

Ligamentous[edit | edit source]

  • Lateral: Lateral collateral/calcaneofibular ligament of the ankle
  • Inferior: Short plantar ligament (at calcaneal tubercle), long plantar ligament (in front of calcaneal tuberosity), plantar aponeurosis (medial process of calcaneal tuberosity proximal to flexor digitorum brevis)
  • Superior: Tarsal sinus ligaments, including:
    • Cervical ligament
    • Talocalcaneal interosseous ligament,
    • Lateral, intermediate, and medial roots of the inferior extensor retinaculum
    • Bifurcate ligament
  • Anterior: plantar calcaneonavicular ligament (anterior margin of the sustentaculum tali of the calcaneus)[3]

Blood Supply[edit | edit source]

  • Medial side of the calcaneus is supplied by perforating branches from the posterior tibial artery.
  • Lateral side of the calcaneus is supplied by the lateral calcaneal artery (can be a branch of the posterior tibial artery or the peroneal artery).
  • Within the bone, there is a watershed area where the medial and lateral intra-osseous arteries anastomose in the midline.[4]

Palpation[edit | edit source]

The posterior aspect of the calcaneus can be palpated directly inferior to the Achilles tendon.

Palpation is also possible around the inferior aspect of the calcaneus particularly the calcaneal tuberosity where the plantarfascia arises.

On the medial aspect the sustentaculum tali is possible to be palpated by palpating the medial malleolus and travelling directly inferior approximately 1-2cm.

Related Pathology[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Palastanga N, Field D, Soames R. Anatomy and human movement. 4th edition. Oxford. Butterworth-Heinemann; 2002. p242.
  2. 2.0 2.1 2.2 Gupton M, Terreberry RR. Anatomy, bony pelvis and lower limb, calacaneous. InStatPearls [Internet] 2018 Dec 6. StatPearls Publishing. Available from:https://www.statpearls.com/kb/viewarticle/18764 (last accessed 12.3.2020)
  3. 3.0 3.1 3.2 3.3 3.4 Radiopedia. Calcaneus. Available from:https://radiopaedia.org/articles/calcaneus?lang=gb (accessed 12/03/2020).
  4. Razik A, Harris M, Trompeter A. Calcaneal fractures: Where are we now?. Strategies in Trauma and Limb Reconstruction. 2018 Apr 1;13(1):1-1.