Calcaneus Fracture: What It Is and How to Heal
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Calcaneus fractures occur when a force that is stronger than the calcaneus itself is applied to the bone. They most commonly occur in high-energy trauma situations.
What is calcaneus fracture?
Calcaneus fractures occur when a force that is stronger than the calcaneus itself is applied to the bone. Calcaneus fractures are rare, although they are the most commonly fractured tarsal bone. These fractures can occur in many different situations, but most commonly occur in high-energy trauma situations such as car crashes or falls from heights (ex. a ladder or roof).
Symptoms generally depend on the severity of the fracture but usually include significant pain, swelling, bruising, numbness, limited mobility, and limping, among others.
Calcaneus fractures can lead to long-term deformity and require good follow-up and management. Treatment options include methods to reduce pain and restore function through surgery or physical therapy.
You should seek immediate medical care at an urgent care clinic or ER. A doctor will confirm the diagnosis with an X-Ray. This condition can be treated non-surgically with a cast. However, if the bones have shifted out of place, surgery may be needed.
Calcaneus fracture symptoms
Symptoms of a calcaneus fracture can depend on the severity and type of fracture experienced. For example, a simple twist of the ankle may result in a single crack in the calcaneus bone. However, in a head-on car accident, the bone can be shattered.
Whether the bone is simply cracked or completely shattered, the symptoms related to calcaneus fracture are often similar between both. Symptoms of calcaneus fracture can include:
- Significant ankle pain: Especially when the heel is squeezed
- Swollen ankle
- Tenderness to the touch
- Pain with movement
- Cracking sound
- Visible deformity of the heel: The heel may appear to widen
- Inability to bear weight on the foot and limited foot mobility
- A hematoma: Another name for a swollen bruise, which may extend to the sole of the foot. This is called Mondor sign and is a strong indicator for calcaneus fracture.
- Limping: This is common in less severe fractures or stress fractures, and occurs because the Achilles tendon supports your body weight and attaches to the calcaneus. In the setting of fracture, the tendon cannot generate enough power to support the extra weight, resulting in foot and ankle instability that affects the way you walk.
Calcaneus fracture causes
Traumas or falls are the most common causes of calcaneus fractures. In addition, repetitive forces and motions, as well as weakened bones (osteoporosis), can result in a type of calcaneus fracture called a stress fracture.
The foot is divided into three parts: the hindfoot, the midfoot and the forefoot. The hindfoot and midfoot are made up of seven bones called tarsals. The calcaneus (also called the heel bone) is the largest tarsal bone of the foot. It is part of the hindfoot and sits directly below the three bones that make up the ankle joint. The three bones of the ankle include:
- The tibia, or shinbone
- The fibula, the smaller bone in the lower leg
- The talus, the small foot bone that works as a hinge between the tibia and the fibula
See this image here for a visual representation of these structures. The calcaneus and the talus form an important joint called the subtalar joint. The subtalar joint is responsible for the side-to-side movement of the hindfoot and is necessary for balance.
Common causes and fracture types
Severe trauma in the form of falls or jumps from great heights as well as motor vehicle accidents are the main culprits for a fractured calcaneus. The greater the impact, the greater the damage to the calcaneus. The heel can even widen, shorten, and become deformed. People with calcaneus fractures can often have multiple other injuries such as fractures of the hip or leg.
There are two types of calcaneus fractures that result from different mechanisms. For example:
- If you land on your feet from a fall, all of your body's weight is directed downward, and this drives the talus bone directly into the calcaneus
- If you are involved in a motor vehicle accident, and your heel is crushed against the floorboard, the calcaneus is driven up against the talus
How to treat calcaneus fractures
Calcaneus fractures can be managed surgically or non-surgically depending on the extent of the fracture and the stability of the broken bone. The goal of treatment is to restore the anatomy of the heel to achieve the best outcomes. Your physician will discuss your treatment options and create a treatment plan that is best for you.
How long does it take for a calcaneus fracture to heal?
Most people return to normal daily activities, excluding sports, within three to four months after injury. However, for severe injuries, complete recovery can require one to two years.
Unfortunately, normal foot and ankle motion is rarely regained after a severe fracture and some people do not typically resume their pre-injury level of function. Anyone who was not very active before the fracture might tolerate a foot that is not normal. On the other hand, someone whose job or recreational activities require a lot of walking or climbing will notice the change much more.
Is Calcaneus Fracture Serious?
If you experience any of the above symptoms related to calcaneus fracture, seek medical attention immediately. It is especially important if you have these symptoms in the absence of any trauma or direct injury.
If your calcaneus fracture is significantly out of place, your calcaneus is considered unstable. Unstable calcaneus fractures require surgery in order to properly heal. The procedure will reposition the bone fragments into their accurate alignment (this is called reduction) and then held together in place with screws or metal plates attached to the outer part of the bone.
If your calcaneus is not out of place or only slightly out of place after the fracture, it is considered stable. Stable calcaneus fractures often do not require surgery and can be healed with options such as casting or appropriately supportive splints or braces in addition to adequate rest and limited to no weight-bearing. The type of treatment you need will be dependent on where the calcaneus is broken and your physician's expert opinion.
Your physician may also prescribe over-the-counter NSAID pain relief medications such as ibuprofen (Advil, Motrin). These medications can help with both the pain and other symptoms such as swelling and bruising. Since calcaneus fractures can be extremely painful, your physician will work closely with you to properly manage your pain.
Depending on the extent and severity of your fracture and the stability of the calcaneus, recovery can be a very long process that can last months to years. It may take even longer for the involved ligaments and tendons to heal. To further assist in your recovery, your physician may also suggest physical therapy. Stretching exercises within a physical therapy/rehabilitation program will help you restore the range of motion, strength, and stability of your calcaneus after the bones have adequately healed.
Complications can often occur with calcaneus fractures both when the fracture happens and during and after surgery.
Minor complications include:
- Small or temporary areas of delayed wound healing
- Nerve irritation around the incision
- Tendon irritation
- Joint stiffness
- Chronic pain
- Chronic swelling
Major complications include:
- Failure of the wound to heal
- Post-traumatic arthritis (with or without surgery)
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.
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