Fractures of the Sustentaculum Tali

  • Jerad D. Allen
  • Michael F. GithensEmail author


Sustentaculum tali fractures are rare injuries seen following a fall onto a varus-placed hindfoot or as part of a constellation of peritalar fracture/dislocations. In isolation, these fractures are often missed or diagnosed late. Frequently, an axial (Harris) X-ray view of the calcaneus and/or computed tomography (CT) scan is needed for diagnosis. Operative intervention is recommended as the sustentaculum plays a key role in maintaining medial column architecture. Additionally, sustentaculum fractures often involve the middle facet of the calcaneus. As such, a fracture of the sustentaculum can cause incongruity of the middle facet and should be treated as an intra-articular fracture. The preferred approach for operative fixation is a medial longitudinal incision centered over the course of the posterior tibial tendon. The outcomes of operative intervention are limited to case reports and case series but demonstrate a preservation of function.


Calcaneus Sustentaculum tali Fracture Constant fragment Hindfoot 


  1. 1.
    Ely LW. Old fracture of the tarsus: with a report of seventeen cases. Ann Surg. 1907;45(1):69–89.CrossRefGoogle Scholar
  2. 2.
    Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004;35(5):443–61.CrossRefGoogle Scholar
  3. 3.
    Al-Ashhab ME, Elgazzar AS. Treatment for displaced sustentaculum tali fractures. Foot (Edinb). 2017;35:70–4.CrossRefGoogle Scholar
  4. 4.
    Pfeifer R, Pape HC. Missed injuries in trauma patients: a literature review. Patient Saf Surg. 2008;2:20.CrossRefGoogle Scholar
  5. 5.
    Della Rocca GJ, Nork SE, Barei DP, Taitsman LA, Benirschke SK. Fractures of the sustentaculum tali: injury characteristics and surgical technique for reduction. Foot Ankle Int. 2009;30(11):1037–41.CrossRefGoogle Scholar
  6. 6.
    Schepers T, Ginai AZ, Van Lieshout EM, Patka P. Demographics of extra-articular calcaneal fractures: including a review of the literature on treatment and outcome. Arch Orthop Trauma Surg. 2008;128(10):1099–106.CrossRefGoogle Scholar
  7. 7.
    Dürr C, Zwipp H, Rammelt S. Fractures of the sustentaculum tali. Oper Orthop Traumatol. 2013;25(6):569–78.CrossRefGoogle Scholar
  8. 8.
    Hall RL, Shereff MJ. Anatomy of the calcaneus. Clin Orthop Relat Res. 1993;290:27–35.Google Scholar
  9. 9.
    Olexa TA, Ebraheim NA, Haman SP. The sustentaculum tali: anatomic, radiographic, and surgical considerations. Foot Ankle Int. 2000;21(5):400–3.CrossRefGoogle Scholar
  10. 10.
    Sora MC, Jilavu R, Grübl A, Genser-Strobl B, Staykov D, Seicean A. The posteromedial neurovascular bundle of the ankle: an anatomic study using plastinated cross sections. Arthroscopy. 2008;24(3):258–263.e251.CrossRefGoogle Scholar
  11. 11.
    Sarrafian SK. Biomechanics of the subtalar joint complex. Clin Orthop Relat Res. 1993;290:17–26.Google Scholar
  12. 12.
    Myerson MS, Berger BI. Nonunion of a fracture of the sustentaculum tali causing a tarsal tunnel syndrome: a case report. Foot Ankle Int. 1995;16(11):740–2.CrossRefGoogle Scholar
  13. 13.
    Wagner UA, Sangeorzan BJ, Harrington RM, Tencer AF. Contact characteristics of the subtalar joint: load distribution between the anterior and posterior facets. J Orthop Res. 1992;10(4):535–43.CrossRefGoogle Scholar
  14. 14.
    Daftary A, Haims AH, Baumgaertner MR. Fractures of the calcaneus: a review with emphasis on CT. Radiographics. 2005;25(5):1215–26.CrossRefGoogle Scholar
  15. 15.
    Huri G, Atay AO, Leblebicioğlu GA, Doral MN. Fracture of the sustentaculum tali of the calcaneus in pediatric age: a case report. J Pediatr Orthop B. 2009;18(6):354–6.CrossRefGoogle Scholar
  16. 16.
    Rammelt S, Zwipp H. Fractures of the calcaneus: current treatment strategies. Acta Chir Orthop Traumatol Cechoslov. 2014;81(3):177–96.Google Scholar
  17. 17.
    Carey DJ, Lance EM, Wade PA. Extra-articular fractures of the os calcis – a follow-up study. J Trauma. 1965;5:362–72.CrossRefGoogle Scholar
  18. 18.
    Burdeaux BD. The medical approach for calcaneal fractures. Clin Orthop Relat Res. 1993;290:96–107.Google Scholar
  19. 19.
    Zwipp H, Rammelt S, Barthel S. Calcaneal fractures–open reduction and internal fixation (ORIF). Injury. 2004;35(Suppl 2):SB46–54.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and Sports MedicineUniversity of Washington/Harborview Medical CenterSeattleUSA

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