Calcaneus Fracture

Heel Bone Injuries From Severe Trauma

calcaneus heel bone
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The calcaneus is the bone in the heel of the foot, commonly referred to as the heel bone. This bone helps support the foot and is important in normal walking motions. The joint on top of the calcaneus, called the subtalar joint, is responsible for allowing the foot to rotate inwards and outwards.

Calcaneus fractures are almost always the result of severe, high-energy injuries. They typically occur as a result of a fall from a height, such as falling from a ladder.

Other causes of a calcaneus fracture include automobile crashes and sports injuries.  The calcaneus can also sustain a stress fracture, an injury sometimes seen in athletes, such as long-distance runners.

Signs of a Calcaneus Fracture

Calcaneus fractures cause swelling and pain of the back of the foot. Common signs of a calcaneus fracture include:

Most calcaneus fractures are closed injuries, meaning the skin is intact. When the skin around the calcaneus fracture is broken, this may represent an open fracture, also called a compound fracture. An open fracture of the calcaneus is an emergency that requires urgent surgery.

Treatment of Calcaneus Fractures

Calcaneus fractures may be treated in a cast or surgery may be recommended. If the calcaneus fracture is not out of position, noninvasive treatment will be recommended. Non-operative treatment is also recommended in patients who have poor circulation or diabetes; these patients are at especially high-risk for developing complications from surgery of the foot.

Patients who are smokers also have a very high risk of complications related to surgery for a calcaneus fracture. Surgery must be carefully considered in these patients, and many doctors believe the risks are too high in smokers to consider surgery.

Surgical treatment of calcaneus fractures usually involves making an incision over the outside of the foot, and placing a metal plate and screws into the broken heel bone.

Your doctor will attempt to restore the normal alignment of the bone and return the cartilage surface as close to normal as possible. Occasionally, if the broken calcaneus is two large pieces of bone (as compared to many small pieces) this surgery can be done with small incisions and no plate. Your doctor can recommend the appropriate treatment based on specific characteristics of your fracture.

In the most severe calcaneus fractures, the calcaneus bone may be fused to the bone above the heel, the talus. In these situations, the chance of restoring joint function of the foot is unlikely, and the fusion procedure can allow a stable foot for walking.

All patients with a calcaneus fracture must also be examined for other high-energy injuries. Studies have shown a large number of patients who have a calcaneus fracture will also have fractures of the lumbar spine (10 to 15 percent). Other injures commonly occur in patients who sustain a calcaneus fracture, including injuries to the head, neck, and other extremities.

Stress fractures of the calcaneus can be treated with noninvasive treatment.  Most often patients will have to be on crutches, and may even require a brief period of cast immobilization.  Stress fractures sometimes take 3-6 months before athletes are able to return to sports following this injury.

Complications of Treatment

Calcaneus fractures are generally severe injuries, and often lead to longstanding problems of the foot and ankle.  Early complications of calcaneus fractures are most often due to the significant swelling that can occur with these injuries. Those patients who have surgery for a calcaneus fracture can develop healing problems as a result of this swelling. As mentioned, patients with diabetes, smokers, and those with poor circulation are especially prone to developing this complication.

Late complications from a calcaneus fracture are most often due to chronic foot pain and arthritis. Arthritis of the hindfoot is common after a patient sustains a calcaneus fracture. The risk of developing arthritis as a result of the calcaneus fracture is generally related to the severity of the fracture. Patients often have problems with chronic foot pain, difficulty with certain types of footwear, and pain associated with walking, running, and prolonged standing.

The recovery period of a calcaneus fracture is an important aspect in determining how well a patient will return to his pre-injury level of activity. Patients will be required to keep weight off of the foot for as long as three months. The other critically important aspect of treatment is controlling swelling, especially in patients who have had surgery. The best ways to control swelling includes elevation, immobilization, and ice application.

Sources:

Barei DP, et al. "Fractures of the calcaneus" Orthop Clin North Am 2002 Jan; 33(1): 263-85.

Juliano P, Nguyen HV "Fractures of the calcaneus" Orthop Clin North Am 2001 Jan; 32(1): 35-51.

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