Causes Heel fractures are the most common of all tarsal fractures, accounting for about 60% of all tarsal fractures. Most of the fractures are caused by vertical impact on the heel after falling from a high place and landing on the foot. 1. Longitudinal fracture of the heel nodule: Mostly caused by a fall from a height, landing on the bottom of the nodule with the heel turned out, and shearing external force on the medial elevation of the nodule. It is rarely displaced and generally does not require treatment. 2. Heel nodule level (beak-shaped) fracture: a kind of Achilles tendon avulsion fracture. If the avulsion bone is small, it does not affect the function of Achilles tendon. If the fracture piece is more than 1/3 of the node, and there is rotation and serious tilt, or serious upward pull, it can be repositioned surgically and fixed with screws. 3, Achilles talonavicular fracture: it is caused by the impact of the talonavicular process inside the talus when the foot is turned inward, which is rare. If there is displacement, the thumb can be used to push it back to the original position and fix it with a short leg cast for 4-6 weeks. 4.Fracture of the front end of the heel bone: less common. The mechanism of injury is a strong inversion of the forefoot plus plantar flexion. X-ray oblique films should be taken to exclude the fracture of the anterior superior heel process, and the short leg cast should be fixed for 4-6 weeks. 5.Fracture close to the heel talonavicular joint: it is a fracture of the heel body, and the mechanism of injury is also caused by a fall of the heel from a high place, or the heel is subjected to a counter-impact force from below upward. The fracture line is oblique, and in the frontal view of the X-ray, the fracture line is oblique from inside to outside, but does not pass through the heel talonavicular joint surface. Because the heel bone is osteophytic, the axial view shows a widening of the heel body on both sides; in the lateral view, the posterior half of the heel body is displaced posteriorly along with the heel tuberosity, causing the abdomen of the heel to protrude into a rocking chair shape toward the center of the foot. Pathogenesis 1, vertical pressure: about 80% of cases are caused by falling or slipping from a height. Depending on the position of the foot at the time of the fall, the direction of the force is not consistent and shows different fracture types, but basically compression fractures are the main cause. In addition, according to the strength and duration of the force, the degree of compression is inconsistently changed. 2. Direct impingement: The fracture at the posterior tuberosity of the heel is mostly caused by the direct impact of external forces. 3, muscle tension: sudden contraction of the gastrocnemius muscle can prompt the Achilles tendon to avulse the heel tuberosity, such as the foot inversion stress is too violent to cause the avulsion of the anterior heel tuberosity; while the external stress causes the talus fracture or the longitudinal fracture of the heel tuberosity, but the latter is rare.