Achilles fracture is a common injury to the foot. It is most common in young adults and is prone to disability after a serious injury. Heel fractures are divided into intra-articular and extra-articular fractures according to whether the fracture line affects the subtalar joint. Extra-articular fractures account for about 30-40% of all heel fractures. They are usually caused by minor violence, do not require surgery, and generally have a good prognosis. Intra-articular fractures account for about 70% of all heel fractures. Because of the involvement of the subtalar articular surface, it may affect the function of the joint. It should be repositioned anatomically. Extra-articular fractures can be classified according to the anatomical location as 1) heel tuberosity fractures 2) anterior heel tuberosity fractures 3) talar fractures 4) heel body fractures. Intra-articular fractures have multiple classification methods. In the past, most of the fractures were classified according to X-ray plain radiographs, such as the most common Essex-Lopresti classification, which divided the fractures into lingual fractures and articular compression fractures, and Sanders classified them into 4 types according to CT scans. The classification is based on coronal CT scans. The fracture line on the posterior talar articular surface after a heel fracture is represented by the corresponding points A, B, and C. The fracture line on the posterior talar articular surface after a heel fracture is represented by the corresponding points A, B, or C, respectively, in the coronal plane. Thus, there may be four fracture blocks, three fracture blocks on the articular surface, and two fracture blocks on the talar process. Type I: All nondisplaced fractures, regardless of the number and location of the fracture line. Type II: two-part fractures, subdivided into IIA, IIB, and IIC fractures depending on whether the fracture is located in A, B, or C. Type III: three-part fractures, also classified as IIIAB, IIIBC, and IIIAC fractures, depending on whether the fracture is located in A, B, or C. The typical fracture has a central compression bone mass. Type IV: Fractures containing all fracture lines, IVABC. or more than four parts of comminuted fractures. Various types of comminuted fractures of the posterior articular surface of the heel can occur due to differences in the morphology of the heel, the direction of the magnitude of the violence, and the location of the foot at the time of injury. However, the following three conditions are often found in clinical practice: 1. After a heel fracture, the talar fracture block always remains in place and has a normal relationship with the talus. The fracture line is often located on the lateral aspect of the intertrochanteric ligament. 2. Articular compression fractures are more common, and Sanders type IIA fractures are more common. The posterior articular surface fracture line is often located in the sagittal plane, and the posterior articular surface is often divided into two parts, with the medial part located on the talus and the lateral part often trapped under the articular surface and rotated outward into the heel due to the impact of the lateral border of the talus.3. The fracture enters the heel due to the impact of the lateral border of the talus on the posterior articular surface of the heel, which pushes the lateral wall of the heel into a prominent elevation. The heel-fibula distance is reduced, resulting in heel-fibula impingement syndrome and peroneal tendon impingement sign. Clinical manifestations and diagnosis The fracture mostly occurs in high falls or traffic accidents. It is common in male young adults. After the injury, the foot swells rapidly within a few hours, and blisters or blood blisters may appear on the skin. If the pain is severe, the foot sensation is impaired, and the passive toe extension causes severe pain, the possibility of foot fascial compartment syndrome should be noted. Other combined systemic injuries such as spinal and spinal cord injuries should also be noted. After heel fracture, the following may occur: 1) destruction of the subtalar articular surface; 2) loss of heel height, especially the medial wall; 3) protrusion of the lateral wall and increase in heel width; 4) inversion of the heel tuberosity. X-ray examination: anteroposterior position of the foot can show whether the fracture affects the heel dice joint. The lateral view can show changes in the heel tuberosity angle and cross angle, and a decrease in heel height. The axial view of the heel bone can show changes in the width of the heel bone and internal and external rotation of the heel bone. CT examination: CT examination should be performed routinely for intra-articular fractures to understand the damage to the subtalar joint surface. Treatment 1. Functional therapy is suitable for patients with no or small displaced fractures, or older patients with low functional requirements or systemic complications that are not suitable for surgical treatment. The application of this method can restore the function of the foot at an early stage of activity for non-displaced or slightly displaced fractures. However, for displaced fractures, the undisplaced fracture may leave widening of the heel, reduction of the joint angle of the nodes, disappearance of the arch and deformity of the inward and outward rotation of the foot, etc., and the patient mostly cannot recover normal function. 2.Closed reduction therapy is applicable to certain lingual fractures in the subtalar joint. Displaced fractures are repositioned by combining some instruments or steel pins. After the fluoroscopic position is satisfactory, a steel needle is inserted into the front of the heel bone. In the case of fracture fragmentation, the pin can also be inserted through the heel dice joint. The pin is then fixed in a plaster cast in the lower leg and the cast and pin are removed after 6 weeks. In this method, the functional recovery is slow due to the long time of fixation with plaster. 3.Cutting and repositioning is applicable to the fracture in the talofibular joint. The cut and reposition can reposition the bone block on the joint surface and the lateral wall of the heel bone under direct vision, combine with traction to restore the axis of the heel bone and correct the shortening and valgus. The use of plate screws can achieve stronger fixation and enable the patient to move early. The function of the foot can be restored as soon as possible to avoid various complications caused by poor repositioning. 4.Joint fusion is suitable for severe intra-articular comminuted fractures. When the patient is young and has high functional requirements, it is difficult to achieve anatomical repositioning of the articular surface by incision, and non-surgical treatment is likely to leave a deformity of the heel bone and affect the function. One-stage fusion and simultaneous restoration of the heel shape can shorten the treatment time and enable the patient to return to work as soon as possible. In the case of incisional repositioning, the patient should also be prepared for joint fusion, but if a better repositioning cannot be achieved, the subacromial joint can also be fused in one stage. During surgery, the articular cartilage is removed with a grinding drill, large bone defects can be implanted, the basic shape of the heel bone is maintained with a plate, and one or two 6.5 mm or 7.3 mm diameter full-length threaded hollow screws are used from the heel tuberosity to the talus via a guide pin. Postoperative plaster fixation is required for 2 months.