The vascularization of the os calcaneum and the clinical consequences

This study was conducted to analyze extraosseous and intraosseous vasculari zation of the os calcaneum and to elucidate possible clinical manifestation s. The arteries of 13 lower leg and foot specimens of human cadavers were i njected with a polymer and subjected to maceration or were embedded in plas tic. The examination revealed that 45% of the bone is vascularized via medi al arteries and 45% via lateral arteries, whereas the remaining 10% is supp lied by the sinus tarsi artery. From the medial side, two or three vessels branch off the posterior tibial artery, penetrate the calcaneus below the s ustentaculum, and supply the medial part of the posterior joint. The latera l calcaneal artery normally is a branch from the posterior tibial artery. I n two of 13 specimens, this lateral supply comes from the peroneal artery. The medial and lateral intraosseous arterial supply for the calcaneus is eq ual. Inside the bone there is a watershed zone where the medial and lateral arterial supply meet in the midline, Only 10% of the blood flow is supplie d by vessels in the sinus tarsi, Clinically, interruption of the lateral ca lcaneal artery during the conventional lateral surgical approach for a calc aneus fracture may result in ischemic bone necrosis, The lateral calcaneal artery could supply a local microvascular flap to cover soft tissue defects of the heel, A compartment syndrome after a calcaneus fracture may be caus ed by bleeding from the medial calcaneal arteries into the quadratus planta e compartment.