Calcaneus (heel bone) Fracture: causes, symptoms and treatment

Updated 12/19/2023

Diego came to UFAI after falling twenty feet from scaffolding. Here's his story.

What's a calcaneus (heel bone) fracture?

A calcaneus fracture is a fracture of the large bone at the heel of your foot

 

Calcaneal fractures are serious injuries usually seen in patients who have experienced a high-energy event that results in axial loading of the bone (stress being applied along the bone’s axis). Landing on your feet after a long fall or being in the front seat during an automobile accident are common mechanisms of injury.

What are the types of calcaneal fractures?

Traumas that cause a fracture of the calcaneus can damage other tissues as well. Some of these injuries are more severe or more difficult to treat than others.

 

The main types of calcaneal fracture include:

 

  • Intra-articular fractures. These involve damage to the cartilage between the joints and are considered the most serious type of heel fracture.
  • Avulsion fractures. This foot fracture includes a sliver of bone splitting off from the calcaneus due to pulling from the Achilles tendon or another ligament.
  • Multiple fracture fragments. This type of fracture is also known as a crushed heel injury.
  • Stress fractures. While most calcaneal fractures are caused by trauma, they can also occur from overuse.
  • Open fractures: A fracture where there is a break in the skin near the area of the broken bone. Also called a compound fracture.

 

 

What are the symptoms of a calcaneal fracture? 

The calcaneus (heel bone) and the talus (the lowest bone of the ankle) comprise the subtalar joint—an essential biomechanical component of flexing, standing, and walking. The calcaneus also forms a joint with the cuboid bones. There are five ligaments connecting the calcaneocuboid joint, making it another essential joint for movement.

 

Because the calcaneus is part of these important joints, an injury to the bone can have many troubling symptoms:

 

  • Sharp, severe heel pain
  • Swelling and bruising in the heel
  • Inability to bear weight on the affected foot
  • General pain in the heel that gradually worsens
  • Blisters may develop around the heel if the fracture causes swelling

 

How is a calcaneal fracture diagnosed?

The first step to diagnosing a calcaneal fracture is a physical examination by one of our foot and ankle specialists. Our doctor will evaluate your foot for swelling, range of motion, and other indicators of joint damage.

 

X-ray imaging can help evaluate the injury by visualizing the bone and calculating the Bohler’s angle. Once we’ve established the extent of the injury, we can determine the best treatment option. For better visualization of the joint, our clinics also have access to CT scans to view the fracture pattern and evaluate if you need surgery.

 

Depending on the cause of your injury, our 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 which occurs when a vertebra in the lower-mid back is crushed.

 

What are the calcaneal fracture treatment options?

Heel bone fractures are notoriously difficult to treat and usually require prolonged healing times. Treating a calcaneal fracture is 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.

 

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 complications, such as an infection or blood loss.

 

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

 

    • About 10-12 weeks of non-weight bearing.
    • Immobilization in a cast or splint for one to two weeks.
    • Elevating the foot at or above the level of your heart.
    • Ice the heel for 10-15 minutes, three times each day to decrease swelling and pain.
    • A compression sock or bandage to hold the joint and reduce swelling.
    • Depending on the pain level, over-the-counter NSAIDs such as ibuprofen or prescription pain medicine can reduce pain while you heal.
    • After two weeks of healing, you can begin physical therapy exercises to restore your range of motion.

 

Surgical treatment 

Surgical correction of a calcaneal fracture takes an extremely skilled surgeon and is inherently risky. Our 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 injury. Operating on an excessively swollen foot may lead to healing problems and can increase the risk of infection.

 

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

 

Percutaneous treatment 

This minimally-invasive surgical technique can be performed on less than 10% of fractures. The surgeon makes a small incision and pierces the pieces of broken bones with a surgical wire. The surgeon can then manipulate the bone fragments into normal alignment.

 

What are potential complications of calcaneal fracture surgery?

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

 

  • Infection. Osteomyelitis 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.
  • Wound complications. 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 that commonly affects patients with healed calcaneal fractures.
  • Nerve damage
  • The inability of the bone to mend
  • Compartment syndrome

 

What is the recovery from calcaneal fracture surgery 

Following surgery, our 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 to allow the heel to sufficiently heal. At two weeks, your specialist may remove the cast and prescribe physical therapy exercises.

 

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.

 

Why UFAI is your best choice for foot and ankle care 

Using the most advanced techniques, some of which we helped develop, has allowed us to maintain the highest success rates in the nation for ankle injuries. Our goal is to quickly get you back on your feet, utilizing the least invasive treatments possible.

 

Patients are our number one priority. Beginning with the ease of making your appointment, our family-friendly office staff is with you every step of the way. We have our own X-ray, musculoskeletal ultrasound, and even an MRI and 3D CT, and many of our facilities.

 

We also offer orthotic and brace manufacturing as well as on-site physical therapy services and state-of-the-art operating rooms. This means you will rarely have to go from one specialist to the next, cutting down on your travel needs and wasted time.

 

Foot and ankle surgeons have more education and training specific to the foot and ankle than any other healthcare provider. While most orthopedic surgeons focus on all the bones and joints in the body, only spending a fraction of their time on the foot and ankle, UFAI's surgeons choose to treat foot and ankle conditions as their lifework.

 

Podiatric foot and ankle surgeons concentrate exclusively on the foot and ankle from day one of medical school. After medical training, they begin a rigorous three-year surgical residency. What sets podiatric surgical residents apart from general orthopaedic surgeons is they specialize in the foot and ankle, while most (though not all) ortho residents do not.

 

Years of training and decades of experience and research are why the foot and ankle surgeons at UFAI have the highest success rates in the United States, literally helping thousands get back on their feet and back to their lives.

 

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

 

University Foot and Ankle Institute podiatry group is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

 

 

Calcaneal fracture FAQs

 

Calcaneal fracture FAQs

 

What are extra-articular fractures? 

Extra-articular fractures happen outside the joint space, meaning they do not directly involve the joint surfaces. This is in contrast to intra-articular fracture lines, which occur within the joint space and can disrupt the joint surface.

 

How common are calcaneal fractures?

Seven bones — called tarsals — make up the hindfoot and midfoot. The calcaneus is the largest of the tarsal bones in the foot. Fractures of the tarsal bones account for only about 2% of all adult fractures, and only half of tarsal fractures are calcaneus fractures.

 

Sources

Adams MR, Koury KL, Mistry JB, Braaksma W, Hwang JS, Firoozabadi R. Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures. Foot Ankle Int. 2019 Jun;40(6):634-640. [PubMed]

 

Renfrew DL, el-Khoury GY. Anterior process fractures of the calcaneus. Skeletal Radiol. 1985;14(2):121–5. [PubMed] [Google Scholar]

 

Shih JT, Kuo CL, Yeh TT, Shen HC, Pan RY, Wu CC. Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis. BMC Musculoskelet Disord. 2018 Mar 09;19(1):77. [PMC free article] [PubMed]

 

Siebert CH, Hansen M, Wolter D. Follow-up evaluation of open intra-articular fractures of the calcaneus. Arch Orthop Trauma Surg. 1998;117(8):442-7. [PubMed]

 

Seat A, Seat C. Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. J Foot Ankle Surg. 2020 Mar-Apr;59(2):356-366. [PubMed]

 

Jiménez-Almonte JH, King JD, Luo TD, Aneja A, Moghadamian E. Classifications in Brief: Sanders Classification of Intraarticular Fractures of the Calcaneus. Clin Orthop Relat Res. 2019 Feb;477(2):467-471. [PMC free article] [PubMed]

  • Foot and Ankle Surgeon at University Foot and Ankle Institute
    Dr. Justin Franson, DPM, University Foot and Ankle Institute, Foot and Ankle Surgeon

    Dr. Justin Franson, DPM, is a Board Certified Podiatric Foot and Ankle Specialist and Diplomate of the American Board of Podiatric Surgery. He attended the School College of Podiatric Medicine in Chicago, graduating in 2001. Dr. Franson then accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital. 

     

    Dr. Franson specializes in several areas including total ankle replacement and sports medicine. Treating athletes and weekend warriors like himself brings him a lot of joy. Dr. Franson keeps active with running marathons, triathlons, hiking, basketball, and golf.

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