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Calcaneus Fracture

What is a calcaneus fracture?

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Updated April 10, 2014

The calcaneus is the bone in the back 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 is responsible for allowing the foot to rotate inwards and outwards.

How does a calcaneus fracture occur?
Calcaneus fractures are almost always the result of high-energy injuries. They usually occur as a result of a fall from a height, such as falling from a ladder. Other causes of a calcaneus fracture include automobile accidents and sports injuries.

The calcaneus can also sustain a stress fracture, an injury sometimes seen in athletes, such as long-distance runners. Stress fractures are a different type of injury from a traumatic fracture, and their treatment is discussed elsewhere.

What are the symptoms of a calcaneus fracture?
Calcaneus fractures cause significant swelling and pain of the back of the foot. Symptoms of a calcaneus fracture include:

    • Inability to walk
    • Swelling of the foot
    • Bruising of the foot
    • Severe heel pain
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, also called a compound, fracture. An open fracture of the calcaneus is a surgical emergency.

What is the treatment of a calcaneus fracture?
Calcaneus fractures may be treated in a cast or surgery may be recommended. If the calcaneus fracture is not out of position, a cast 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 some doctors will refuse surgical intervention if patients do not agree to quit smoking.

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 your particular fracture.

In the most severe calcaneus fractures, the calcaneus bone may be fused to the bone above the heel. In these situations, the chance of restoring the cartilage of the foot is unlikely, and the fusion procedure should 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.

What are the complications of calcaneus fractures?
Calcaneus fractures are generally quite severe injuries, and often lead to longstanding problems of the foot and ankle. The complications of calcaneus fractures can be separated into early and late complications.

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.

What is the recovery from a calcaneus fracture?
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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  6. Fracture - Calcaneus Fracture - Broken Heel Bone

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