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

Updated 4/7/2022

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

What's a Calcaneus (heel bone) Fracture

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


Calcaneal fractures are serious injuries 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 a motor vehicle collision when an excessive force crushes the heel bone against the talus.


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.

Types of Calcaneal Fractures

The traumas that cause fracture of the calcaneus 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 trauma, this type of fracture can result 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.



Symptoms of a Calcaneal Fracture

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



Diagnosing Fractures of the Calcaneus

If you have recently experienced 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 and the best treatment options. Your doctor may also order a CT scan to get a better idea of the fracture pattern, 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. 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.


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 very nearly as effective as surgical treatment. Typically, non-surgical treatment involves:

    • No weight-bearing 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 it 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 the proper position with screws and metal 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 broken bones with a surgical wire. The surgeon can then manipulate the bone fragments into normal alignment.



Complications of Calcaneal Fracture Surgery

Surgical correction 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 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 that commonly affects patients with healed calcaneal fractures.
  • Nerve damage
  • The 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.


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 aad 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.


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 orthopedic residents 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 is 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 life.

  • 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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