Calcaneal Fracture: broken heel

Updated 12/1/2017
Calcaneal Fracture, Broken Heel, Univerity Foot and Ankle Institute

A calcaneal fracture is a fracture of the heel bone (the calcaneus). It is serious and painful injury, and unfortunately it is quite common. Calcaneal fractures are usually seen in patients who have landed on their feet after a long fall, or who were in the front seat of a car during an accident.

 

Our team of physicians are trained trauma specialists and have decades of combined experience treating fractures of the foot and ankle. They offer advanced care in a compassionate, relaxed environment with the highest success rates in the nation.

Causes of a Calcaneal Fracture

A calcaneal fracture occurs when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle). The joint between the calcaneus and the talus is known as the subtalar joint, and it is an essential biomechanical component of flexing, standing, and walking.

 

Treating a calcaneal fracture is extremely tricky, because the fracture is rarely a clean break like you might see in a broken shin or arm. Think of the calcaneus as a hard-boiled egg: its outside layer is hard and brittle, while the inner tissue is soft and spongey. When you crack a hard-boiled egg, the shell shatters. When the calcaneus fractures, the hard outer layer can break into irregular fragments.

 

Types of Calcaneal Fractures

The traumas that cause heel bone fractures can damage other tissue as well. Some of these injuries are more severe or more difficult to treat than others.

  • Intra-articular fractures. These involve damage to the cartilage between the joints, and are considered the most serious type of heel fracture.
  • Avulsion fractures. A sliver of bone is split off from the calcaneus due to pulling from the Achilles tendon or another ligament.
  • Multiple fracture fragments. This is also known as a crushed heel injury.
  • Stress fractures. While most calcaneal fractures are caused by a trauma, a calcaneal stress fracture can result from overuse.

 

Symptoms of a Calcaneal Fracture

  • Sharp, severe pain
  • Swelling and bruising in the heel
  • Inability to bear weight
  • A general pain in the heel that gradually worsens could be a sign of a stress fracture

 

Diagnosing Calcaneal Fractures

If you have recently experienced a trauma and experiencing symptoms of a calcaneal fracture, visit your foot and ankle specialist. Your doctor will evaluate your foot for swelling and other signs of a fracture or joint damage. X-ray imaging can be helpful in making a diagnosis. Your doctor may also order a CT scan to get a better idea of the pattern of the fracture, to determine whether surgery is needed.

 

Depending on the cause of your injury, your foot and ankle specialist may also examine you for an ankle or mid-foot injury, or refer you to another specialist to check for injuries beyond the foot. About 10% of patients with calcaneal fractures also suffer a back injury called a Lumbar spinal burst fracture. This occurs when a vertebra in the lower-mid back is crushed.

 

Calcaneal Fracture Treatment

Heel bone fractures are notoriously difficult to treat, and usually require prolonged healing times. Your foot and ankle specialist will assess your injury and determine whether to treat the fracture surgically or non-surgically.

 

Non-Surgical Treatment

A conservative, non-invasive treatment regimen may be recommended for patients who are not good candidates for surgery. Smokers, elderly patients, and patients with diabetes or vascular disease may be at higher risk for surgical complication, such as an infection or blood loss.

 

As severe as calcaneal fractures can be, studies have shown that non-surgical treatment can be very nearly as effective as surgical treatment. Typically, non-surgical treatment involves:

  • Bearing no weight on the foot for 10-12 weeks
  • Immobilization in a cast for 1-2 weeks
  • Elevation of the foot. When resting, prop your foot up on stools or pillows to keep it above your heart.
  • Icing. Wrap a bag of ice in a washcloth and place on the heel for 10-15 minutes, three times each day.
  • Compression. Wrap your heel in a compression sock or bandage.
  • Pain medication. Your doctor may prescribe you pain medication or you can take over-the-counter NSAIDs, such as Ibuprofen and Naproxen.
  • Physical therapy exercises. After 2 weeks, practice drawing a figure-8 with the toes to increase your range of motion in the ankle.

 

Surgical Treatment

Surgical correction of a calcaneal fracture takes an extremely skilled surgeon, and is inherently risky. Your surgeon will reconstruct the heel bone to something close to its original shape. Because each fracture is different, each surgical procedure is highly individualized.

 

Typically, surgery cannot begin until the swelling has gone down, about 10-14 days following the trauma. Operating on an excessively swollen foot may lead to healing problems and it can increase the risk for infection.

 

The surgery is generally performed through an open incision on the outer side of the heel. The surgeon then carefully repositions the fragments and fixes them into place with screws and plates.

 

Percutaneous treatment. This is a minimally-invasive surgical technique that can be performed on some fractures (less than 10%). The surgeon makes a small incision and pierces the pieces of fractured bone with surgical wire. The surgeon can then manipulate the pieces into place.

 

Complications of Calcaneal Fracture Surgery

Surgical correction of a fractured heel bone is a risky procedure. Common complications include:

  • Infection. Osteomylelitis is a severe deep-wound infection that affects the bone, and the calcaneus is particularly vulnerable. In many cases, a bone infection must be treated with amputation.
  • Would healing problems. Because circulation to the heel’s soft tissues is relatively weak, the surgical site may not heal properly.
  • Subtalar arthritis. This is a chronic pain condition which commonly affects patients with healed calcaneal fractures.
  • Nerve damage
  • Inability of the bone to mend

 

Recovery from Calcaneal Fracture Surgery

Following surgery, your foot and ankle specialist will likely immobilize your foot in a cast to allow the bone and joints time to heal. You should follow the at-home treatments recommended for non-surgical patients, including rest, ice, elevation, and compression.

 

You should avoid bearing weight on the foot for 10-12 weeks until it is sufficiently healed. At 2 weeks, your specialist may remove the cast and prescribe physical therapy exercises.

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