Calcaneal Fractures (Heel Bone Fractures)

What is the Calcaneus?

The calcaneus, also called heel bone, is a large bone that forms the foundation for the back of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and the calcaneus forms the subtalar joint. This joint is important for the normal functioning of the foot. The calcaneus is often compared to a boiled egg, because it has a thin, hard shell on the outside and a softer, fluffy bone inside. When the outer covering breaks, the bone tends to collapse and fragment. For this reason, calcaneal fractures are serious injuries. Furthermore, if the fracture involves the joints, there is a potential for long-term consequences such as arthritis or chronic pain.

How Calcaneal Fractures Occur?

Most calcaneal fractures are the result of a traumatic event-most commonly, falling from a high place, such as a ladder, or suffering a car accident in which the heel is crushed to the floor. Calcaneal fractures can also occur with other types of injuries, such as a sprained ankle. A smaller number of calcaneal fractures are stress fractures, caused by excessive use or repetitive strain on the heel bone.

Types of Calcaneal Fractures

Calcaneal fractures may or may not involve the subtalar joint and the surrounding joints. Fractures that involve the joints (intra-articular fractures) are the most severe calcaneal fractures, and include cartilage damage (the connective tissue between two bones). The recovery forecasts depend on the severity of the crushing of the calcaneus at the time of injury. Fractures that do not involve the joint (extra-articular fractures) include:

• Those caused by traumas, such as avulsion fractures (in which a piece of bone is pulled from the calcaneus by the Achilles tendon or a ligament) or crush injuries that produce multiple fractured fragments
• Fractures due to overload, caused by overuse or minor injuries. The severity and treatment of extra-articular fractures depend on their location and size.

Signs and Symptoms

Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic fractures or overload. Signs and symptoms of traumatic fractures may include:

• Sudden pain in the heel and inability to support weight in that foot
• Swelling of the heel area
• Bruises on the heel and ankle Signs and symptoms of stress fractures may include:
• Generalized pain in the heel area that usually develops slowly (over the course of several days to weeks)
• Swelling of the heel area

Diagnosis

To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask you questions about how the injury occurred, examine the affected foot and ankle, and order radiographs. In addition, advanced diagnostic imaging tests are usually required.

Treatment

The treatment of calcaneal fractures depends on the type of fracture and the degree of the injury. The foot and ankle surgeon will talk to the patient about the best treatment - either surgical or non-surgical - for the fracture. For some fractures, non-surgical treatments may be used. These include:

• Rest (rest), ice (ice), compression (compression) and elevation (RICE) (RICE)  The  rest  (not rely on the injured foot) is necessary to allow the fracture to heal. The  ice  reduces swelling and pain; Place an ice pack covered with a thin towel on the affected area. The  compression  (wrapping the foot with an elastic bandage or wear a compression stocking) and  elevation  (keeping your foot at or slightly above heart level) also reduce swelling.
• Immobilization. Sometimes the foot is cast or a plaster boot should be used to prevent the fractured bone from moving. It may be necessary to use crutches to avoid bearing weight on the foot. For traumatic fractures, treatment often involves surgery to rebuild the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical treatment for the patient.

Rehabilitation

Whether the treatment of a calcaneal fracture has been surgical or non-surgical, physiotherapy often plays a key role in the recovery of strength and functional restoration.

Complications of Calcaneal Fractures

Calcaneal fractures can be serious injuries that can lead to lifelong problems. Arthritis, stiffness and pain in the joint often develop. Sometimes the fractured bone can not be cured in the proper position. Other possible long-term consequences of calcaneal fractures include decreased ankle mobility and limping walking due to collapse of the heel bone and loss of leg length. Patients often require additional surgery and / or long-term or permanent use of a brace or brace (arch support) to help manage these complications.