In comminuted and in impacted fractures with persistent
deformity, complete excision of the bone yields good results.

The #calcaneus# is most frequently broken by the patient falling from
a height and landing on the sole of the foot, and the injury may occur
simultaneously in both feet.

The primary fracture is usually longitudinal, passing through the
facets for the talus and cuboid, and from this various secondary
fissures radiate; the cancellated tissue is much crushed, so that the
whole bone is flattened out. In spite of the great comminution, it is
often impossible to elicit crepitus, as the fragments are held
together by the investing soft parts. In other cases the foot may feel
like "a bag of bones." The lesion is often mistaken for a fracture of
the lower end of the fibula, or is not diagnosed at all. The chief
clinical feature is pain on movement of the foot, or on attempting to
walk; the foot appears flat, and the hollows on either side of the
tendo Achillis are filled up. In many cases there is a persistent
tenderness which delays restoration of function for some months, but
the ultimate result is usually satisfactory.

_Treatment._--In simple comminuted fractures the patient should be
anaesthetised, and the foot moulded into position, care being taken to
restore the arch in order to avoid any tendency to flat foot. The foot
is supported on a pillow, and to prevent stiffness, massage and
movements of the ankle and tarsal joints should be commenced without
delay.

Compound fractures confined to the calcaneus may be treated on
conservative lines, but if associated with other injuries of the foot
they may necessitate amputation.

_The tuberosity of the calcaneus_, into which the tendo Achillis is
inserted, is sometimes separated by forcible contraction of the calf
muscles, or from a fall on the ball of the foot. The separated
fragment may be pulled up for a distance of 1 or 2 inches, and the
rough surface from which it has been torn may be recognisable. The
patient may be able to walk immediately after the accident, although
with difficulty; or he may have pain for many months.

A good functional result is usually obtained by relaxing the calf
muscles and fixing the foot in the position of extreme plantar flexion
with the knee flexed, but in some cases it is advisable to peg the
fragments, either through the skin or after exposing them by
operation.

The #other bones of the tarsus# are rarely fractured