Heel swelling after a fall

A woman in her 70s presented to the emergency department with pain and difficulty weight bearing after she tripped and injured her left heel five days previously. She was able to partially weight bear, but only for short distances, and had been taking over-the-counter analgesia, which did not alleviate the pain. She had no history of previous injury to that foot. She had a history of gastro-oesophageal reflux disease and osteoporosis, for which she took omeprazole and combined calcium/vitamin D supplements.

Clinical examination revealed significant tenderness and swelling over her left heel, with an area of contusion around the heel and tenting of the skin. No neurovascular compromise was evident. A radiograph of the ankle was …