A calcaneus fracture is a broken heel bone. There are two types of calcaneus fractures: one involves the subtalar joint and one does not involve the joint.
The subtalar joint is formed by the calcaneus and the bone above it, which is called the talus. This joint allows side-to-side motion of the foot, which is important for walking on uneven surfaces. Calcaneal fractures that involve the subtalar joint are usually the most severe.
Symptoms of a heel fracture include pain, swelling and bruising of the heel. Patients usually are unable to walk. In fractures with severe swelling, blisters may develop around the heel.
High-energy injuries usually cause calcaneus fractures that involve the subtalar joint. Falls from a height and car accidents are the most common causes. Low-energy injuries such as twisting the ankle can cause smaller chips or bone fragments to break off from the edges of the calcaneus. These are called avulsion fractures. These do not usually involve the joint surfaces.
X-rays along with physical examination are used to diagnose fractures of the calcaneus. A CT scan may be needed to look more closely at the pieces of the fracture or to see aspects that are not seen on the X-rays.
Some heel fractures can be treated without surgery. The foot can be placed in a split or a removable fracture boot so that patients can work on ankle and foot motion. The amount of time that the patient has to keep weight off of the foot depends on the severity of the fracture.
Surgery may be recommended if the fracture involves the joint and pieces are displaced. A plate and/or screws may be used to hold the pieces of the fracture in place. With a severe fracture, a fusion of the subtalar joint also may be recommended.
Recovery can take a long time. The period of non-weightbearing usually lasts for 8-12 weeks. Physical therapy can help with motion and improve the function of the foot.
Calcaneus fractures are significant injuries. Pain, stiffness, and swelling may last for months or indefinitely depending on the severity. Most people are able to return to work and recreational activity once their recovery is complete.
Healing of the surgical incision can be a problem after surgical treatment of heel bone fractures. These usually resolve with local wound care, however, deep infections can occur and may need more surgical treatment. Other complications can include permanent stiffness of the subtalar joint after a calcaneus fracture, limiting side-to-side motion of the foot. Fractures that involve the subtalar joint can develop arthritis over time. Painful arthritis is treated with injections, bracing and sometimes a surgery to fuse the subtalar joint.
Calcaneus fractures may cause heel widening, making it difficult to fit into a shoe. This may be able to be treated surgically.
Additionally, the tendons that pass along the outer border of the calcaneus can become damaged or irritated. This can be treated with bracing or surgery.
When can I return to exercise and activity?
Fractures of the heel bone can be devastating injuries. Returning to exercise and recreational activity can be difficult. Most people can resume low-impact exercise (swimming, biking, or elliptical machine use) a few months after their injury. Returning to high-impact exercise (running, jumping, and hopping) takes longer. Sometimes the injury is so severe that returning to high-impact activity is not possible.
Original article by Jacob Zide, MD
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