Para leer este artículo en español, haga clic aquí.

 

What Is a Calcaneus Fracture?

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

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 foot and the heel.

Causes

Calcaneus fractures that involve the subtalar joint are usually a result of high-energy injuries. 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. They do not usually involve the joint surfaces.

Diagnosis

Your foot and ankle orthopaedic surgeon will use X-rays along with a physical examination to diagnose fractures of the calcaneus. A CT scan may be necessary to look more closely at the pieces of the broken bone or to see aspects that are not seen on the X-rays.

Treatments

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.

Your foot and ankle orthopaedic surgeon may recommend surgery if the fracture involves the joint and pieces are displaced (not in good alignment). A plate and/or screws may be used to hold the pieces of the fracture in place. With a severe fracture, your surgeon may recommend a fusion of the subtalar joint at the same time as the calcaneus fracture repair due to the high chance of developing arthritis in the joint.

Recovery

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 of the damage to the bone and cartilage. Most people are able to return to work and recreational activity once their recovery is complete.

Risks and Complications

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, which limits 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 can be treated surgically.

Additionally, the tendons that pass along the outside of the heel bone can become damaged or irritated as a result of the injury. 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
Contributors/Reviewers: Jeffrey Feinblatt, MD; Wen Chao, MD

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.