A broken heel refers to a fracture of the calcaneus, the largest bone in the foot. While not as common as some other bone fractures, calcaneus fractures are significant injuries that can result from various forces.
Heel Anatomy and Fracture Types
The calcaneus, or heel bone, is a large, irregularly shaped bone situated at the back of the foot. It plays a primary role in supporting body weight and absorbing shock during activities like walking and running. The calcaneus articulates with the talus bone above it, forming the subtalar joint, which allows for side-to-side motion of the foot.
Fractures of the calcaneus are categorized into two types: intra-articular and extra-articular. Intra-articular fractures involve the subtalar joint and often result in damage to the cartilage within the joint, leading to long-term complications. Extra-articular fractures occur outside the joint and have a more favorable prognosis. Fractures can also be described as displaced, meaning bone fragments shift out of alignment, or non-displaced, where the bone remains in position.
Causes and Symptoms
Calcaneus fractures commonly occur due to high-energy events that impact the heel bone. Falls from a height and motor vehicle accidents are frequent causes. Less severe incidents like a forceful jump, blunt trauma, or a twisting injury can also cause a calcaneus fracture. Stress fractures, which are small breaks, can develop from repetitive overuse, such as prolonged walking or running.
Following a calcaneus fracture, individuals experience severe heel pain. Swelling and bruising are common, extending to the sole. Weight-bearing on the affected foot is difficult or impossible. The heel may appear wider or deformed, and limited foot mobility. If a broken bone presses on nearby nerves, numbness or tingling can occur.
Diagnosis and Treatment
Diagnosing a calcaneus fracture begins with a physical examination, assessing pain, swelling, and deformity in the heel. Imaging techniques confirm the fracture and determine its severity. Plain X-rays are the initial step. Computed tomography (CT) scans are necessary to gain a detailed view of fracture lines and assess joint involvement.
Treatment approaches for calcaneus fractures vary depending on the type and severity. Non-surgical options are for non-displaced or minimally displaced fractures. These treatments involve rest, ice, elevation, and immobilization with a cast or boot for 6 to 8 weeks for healing. During this period, weight-bearing on the injured foot is not permitted.
Surgical intervention, through open reduction and internal fixation (ORIF), is recommended for displaced fractures, especially for subtalar joint involvement. Surgery aims to realign and stabilize fractured bone fragments using plates and screws. This restores heel shape, corrects alignment, and improves foot function. Surgery is performed within three weeks after the injury, once initial swelling has subsided.
Recovery and Outlook
Recovery from a calcaneus fracture is a lengthy process that varies based on complexity and treatment. A non-weight-bearing period, lasting 8 to 12 weeks, is necessary for adequate bone healing. During this time, crutches, a walker, or a wheelchair are used for mobility.
Physical therapy is a key part of rehabilitation, to gradually regain range of motion and strength in the foot and ankle. Early motion exercises are encouraged once healing allows. As healing progresses, weight-bearing is slowly introduced, guided by medical imaging and professional advice.
Despite appropriate treatment, individuals may experience challenges such as chronic pain, stiffness, or subtalar joint arthritis. Gait changes or a limp may occur. While many return to daily activities, regaining full function, especially for high-impact activities, can be difficult to achieve. Long-term considerations include footwear issues from changes in heel shape or discomfort from surgical hardware.