Location of the Calcaneus
The calcaneus is the largest tarsal bone located in the heel of the foot, positioned posteriorly and inferiorly in the hindfoot. 1, 2
Anatomical Position and Relationships
The calcaneus occupies the posterior-most position among the tarsal bones and forms critical articulations with surrounding structures:
- Superior articulation: The calcaneus sits directly beneath the talus, forming the subtalar (talocalcaneal) joint posteriorly and contributing to the talocalcaneonavicular joint anteriorly 3, 4
- Anterior articulation: The calcaneus articulates with the cuboid bone at its anterior aspect 4
- Posterior aspect: The posterior portion of the calcaneus forms the prominence of the heel, where the Achilles tendon inserts 3
Key Anatomical Landmarks
The calcaneus can be identified by palpable bony landmarks, particularly on the lateral aspect where soft tissue coverage is relatively sparse 1:
- Posterior superior calcaneus: This prominence is the site of Achilles tendon insertion and can be involved in Haglund's deformity 5
- Lateral calcaneal wall: Located slightly posterior to the subtalar joint facet, this area is tender in calcaneal stress fractures 5
- Medial aspect: Major neurovascular structures run along the medial side, well-protected by soft tissues 1
Clinical Examination Context
During physical examination of ankle trauma, the calcaneus is specifically assessed as part of the Ottawa Ankle Rules, where point tenderness over the calcaneus indicates need for radiographic evaluation 3, 5. The calcaneal squeeze test—compression from medial to lateral—helps identify stress fractures 5.
Imaging Visualization
On standard imaging, the calcaneus is visualized:
- Lateral radiographs: Show the calcaneus in profile posterior to the talus 3
- Axial Harris-Beath view: Specifically designed for evaluating calcaneal fractures and intra-articular extent 3
- Ultrasound: The calcaneus appears on posterior longitudinal scans of the heel, positioned deep to the Achilles tendon with Kager's fat pad interposed 3