Our Dr.’s Most Interesting Cases: the Heel that wouldn’t Heal!

An most interesting case of mine involves a 69 year-old male who came to me four months after shattering his heel bone (or calcaneus).  He was trimming branches on a ladder about 6 feet high when he fell and landed right on his heel bone.  He went to urgent care, where x-rays were taken, revealing no obvious fracture.  He then went on to see another foot specialist, who diagnosed him with a heel fracture, and treated his injury conservatively with immobilization in a walking cast boot.

After four months of immobilization, he was sent for a CT scan, which revealed a shattered heel bone within the joint, and by then it had healed in a poor position.  It was decided to order a bone stimulator for the patient to help this fracture heel.

At this point the patient came to me at UFAI for a second opinion. By now he was terribly discouraged and wondered why it would take so long for his fracture to heal.  Plus he was having a lot of pain when he walked, even in the walking cast boot.

Now clinically, the patient had no pain when I squeezed his heel bone, but the bone was in an inverted, or varus position.  He had pain along the tendons that run along the outside of the heel, stiffness and pain along the subtalar joint as well (the joint just below the ankle).

I decided to start from ground zero and ordered a set of x-rays, which we took in our office, which revealed obvious arthritis in his subtalar joint, a s well as malalignment of the heel bone in a varus position.

After listening to his story , doing my examination and reading his  radiographs (aka x-rays) it was clear that he had initially suffered a bad injury that was not properly treated from the beginning. Now he had two bad issues that was causing him continued pain and swelling: a malunion of his heal and post-traumatic arthritis.  A bone stimulator, which his prior doctor ordered, was never going to resolve this issue.

About his Malunion

Calcaneal fracture,

Fracture of the heel.

In the time before he came to see me his heel fracture had healed but unfortunately in a bad position, changing his gait and putting more pressure on the outside of his foot and ankle.  Neglected or poorly treated heel fractures will typically heel mal-aligned, in a varus or inverted position, leading to increased stress on the outside of the extremity.

Additionally, due to the compressive nature of the fracture there was a loss of height, or flattening of the heel.  Left untreated this can lead to limb length discrepancies and subsequent compensatory issues if not properly treated.

About his post-traumatic arthritis

Due to the intraarticular nature of the fracture – meaning that the fracture violated the joint – there were now signs of arthritis in the joint.  Heel fractures that violate the joint – the subtalar joint in this case – have a high risk of subsequent arthritis.  If properly reduced, the risk is lessened, but there is still a chance of arthritis.  In this patient’s case, his displaced fracture within the joint that was not originally reduced back into its anatomical alignment.  Due to this, arthritis began developing in the subtalar joint which was due to the mal-alignment of the joint.

How we treated this condition

The surgical plan to correct this patient’s malunion was to make a wedge cut in the heel bone to reduce the varus deformity in the heel.  This would make the heel more neutral and reduce the amount of stress he is putting on the outside of his heel.  I would then attempt to fuse the subtalar joint, adding a bone graft in that joint to recreate some height to the heel.  During the surgery, I would also remove any bone spurs, and inspect for any tendon damage to the outside tendons of the foot (peroneal tendons).   The goal of the surgery was to provide a functional and stable foot for the patient to walk on.  The patient agreed to proceed with this course of treatment.

Results

After surgery, the patient was immobilized in a cast for 2 months, and then placed in a walking boot for 1 month, after seeing evidence of bone fusion of the subtalar joint, and bone cut.  Physical therapy was performed for a couple of months afterwards.

Currently the patient is doing very well.  He is walking without any pain or and the swelling he was experiencing before he came to see me was totally gone.   He is very happy with the surgery and has ended up with a perfectly functional foot which pleases both him me tremendously!

Dr. Yau is available for consultation at our Valencia office. Please call (877) 989-9110 or visit us at www.footankleinstitute.com for more information.

The UFAI Education Team

The UFAI Education Team

For almost fifteen years, University Foot and Ankle Institute and their nationally recognized physicians have been providing the most technologically advanced medical care for the foot and ankle with the highest success rates in the country.

As a teaching institution, University Foot and Ankle Institute’s Fellowship Program is among the most advanced in the nation.

We at UFAI are driven to get our patients back to their normal activities with the highest level of function, in the least amount of time, using the least invasive treatments possible. From start to finish, we are with you every step of the way.

The UFAI Education Team works to help empower our patients and website visitors with the most up-to-date information about foot and ankle conditions, treatment options, recovery and injury prevention. Our goal is to pass on truly useful information to our readers.

We hope you enjoy our work and find it of value. Please let us know!
The UFAI Education Team

11 comments

  1. 8 years ago I fell off the roof, and shattered both heels. Surgery was done only on the right one. MERSA developed, and all hardware was removed, and I now have bilateral pain in ankle joints and heels. The right is by far the worst. It feels as though my right leg is longer than the other, and I have developed pain in my lower right spine. I don’t know if it’s related to over-compensation or not, since my vertebrae in that area was also fractured, and surgically repaired from the fall. I’ve been told that the only treatment left is fusion, but that will not relieve the heel pain, nor correct my back pain. I will be 70 years old next year, and after all of the complications I’ve endured after 3 surgeries on my heel, I despise the thought of going through any more. I have been on opiates for all these years, and an stuck between a rock and a hard place. What would be your recommendation as far as treatment for a person my age?

    • We are all so sorry to read your post, that is not a good place to be in. And on top of everything else, you got MERSA, that is terrible. We hope you have fully recovered from that at the very least.

      Unfortunately, we cannot give advice via blog, chat or email. Each case is really different and a full history, medical record and films/MRI review would need to be done to even begin to discuss your case.

      We do offer a virtual consultation service, though it is almost never covered by insurance, which can make it hard for some people. Of course we can see you in person, but to travel to where we are is also not something that is possible for everybody, which is why we offer the virtual consultation service.

      I personally hope you can find someone close to you who you can trust and can give you some honest and straightforward options to improving your situation. If you want to let me know where you are located, I can ask if we know anyone remotely close to you. We usually don’t, but sometimes, depending on where you are, one of our doctors may know someone who is a quality physician. I would be more than happy to ask everyone if you want.

      I thank you for visiting us and truly wish you all the very best.

      Christie

  2. I fell 17′ onto concrete from a ladder, in June 2016, shattered both calcaneus ( both repaired with plates & screws-12 screws in one 13 in the other) broke right femur ( required 47 cm Titanium rod), broken right hip, ( nothing done to date) burst L-1 vertebrate (nothing done to date), broken neck (nothing done to date). This accident happened on the job is covered by SAIF of Oregon, I am walking, but not long with terrible pain that I ice down with filled frozen water bottles, rolling them. Aqua-therapy has been ordered, but can’t be done until a incision area has completely healed on my heal. (5.5 months not completely healed)

    My Question,is there a support group online you know of that helps with ideas for people with surgically related calcaneus?

    Thank you 55 yr old male

  3. i feel off from 10′ high shattered heal bone several pieces dr wants to do surgery and put in pin following another surgery removing catalege. is this advisible?

    • Dr. Bob Baravarian

      Hi, thanks for stopping by. I am sorry to read about your fall.

      If it is badly damaged, a fusion may be suggested. Unfortunately it is hard to tell without seeing you or doing a virtual consultation and reviewing all your films and records.

      Sorry I cannot be of more help via our blog.

      Dr. Bob Baravarian
      Assistant Clinical Professor:
      UCLA School of Medicine
      Director and Fellowship Coordinator:
      University Foot and Ankle Institute

  4. I do wish there were an answer regarding a support group on line for these things. I fell off my second story balcony and crushed my right heel, which probably saved my life as I landed on my back on concrete. I tore through my subtalar and broke my tailbone. I’m a single mom of a teenager. I’m entering my second month with a hard cast. Would be great to talk to others in this situation.

    Caron
    Studio City, Ca

    • Hi Caron,

      I am so sorry to read about your condition, that is so very hard. And then being a single Mom on top of all that, it is amazing you can even find time to ask a question.

      I wish we knew of some support groups, but honestly we do not. But if you find some resources, would you please let us know so we can pass them on to others? It would be great to not have to say “I do not know” ever again when someone asks for support group info.

      Until then, I wish you all the very best in mending and please stay strong.

      Warmly, Steven

  5. Hi.54 year old guy. I fractured my heel on 5/25/17. 10 days my cast comes off after 8 weeks!! Does anyone know how long I have to wear a walking boot,excited for next part of recovery. No complications so far.healing,infection,etc.

    • Hi William,

      So far, so good it seems. Of course, you should ask this question to your own doctor since he knows you and your condition the best.

      As a general rule, we advise that the right time for the boot to come off truly depends on you symptoms. If there is no pain or changes in boney position, the boot would most likely be removed after 2 weeks.

      I hope this helps and all the best,

      Gary

      Dr. Gary Briskin
      Assistant Clinical Professor
      UCLA School of Medicine
      Director, University Foot and Ankle Institute

  6. Hello, I fell off a great height (14ft) about 10yrs ago. I am lucky to be alive, fractured my calceneous bone and had plates and screws implanted, recovery went well but if I walk too much my foot swells up and I am immobile for a couple of days. Is this normal after so long?

    • Steph,

      Yikes, that sounds miserable and I am so glad you are still among us! To answer your question about pain after 10 years being normal, the best answer to that is you should not have to live in pain, in most cases. You should see a very competent foot and ankle specialist and see what, at this point, can be done to help resolve your pain or, at least, make it appreciable better.

      Living in pain sucks, there is no other way to say it, and I hope you are able to get this looked into. Please do not put it off!

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