The calcaneus, commonly known as the heel bone, is the largest bone in the foot. It sits at the back of the foot and is an important part of the hindfoot, articulating with the talus and cuboid bones. This robust bone plays a central role in supporting body weight and facilitating movement. Its structure allows it to absorb impact and provide leverage for the calf muscles.
How Heel Fractures Occur
Heel fractures result from high-energy events that exert significant force on the foot. Common causes include falls from heights, where the impact of landing drives the talus bone into the calcaneus. Motor vehicle accidents, particularly high-speed collisions, can also lead to severe heel fractures. Direct crushing injuries or a simple ankle twist are another mechanism.
Signs of a Broken Heel
A broken heel presents with immediate symptoms due to the injury’s significant force. Severe pain in the heel is a primary indicator, making weight-bearing impossible or extremely difficult. Swelling around the heel and ankle develops rapidly, accompanied by extensive bruising that can spread to the sole of the foot. In some cases, the heel may appear visibly deformed or widened.
Confirming a Heel Fracture
Confirming a heel fracture involves physical examination and imaging studies. Doctors assess for swelling, bruising, and tenderness, but imaging provides definitive evidence. X-rays are the initial diagnostic tool, revealing the break and any bone displacement. Given the heel bone’s complex structure, a computed tomography (CT) scan is often necessary after X-rays. CT scans offer a detailed, three-dimensional view of the fracture pattern, including subtalar joint involvement, which guides treatment.
Paths to Healing and Recovery
Treatment for a heel fracture depends on the severity of the break. Less severe fractures, especially those not involving the joint or significantly displaced, may be managed non-surgically. This involves immobilization with a cast or boot, non-weight bearing for several weeks to months, and rest. Imaging monitors alignment during this period.
More complex fractures, particularly those involving the subtalar joint or displaced fragments, require surgical intervention. Open reduction and internal fixation (ORIF) is a common surgical procedure where surgeons realign and secure bone pieces with plates and screws. ORIF aims to restore heel anatomy and subtalar joint function.
Rehabilitation is essential after treatment. Physical therapy begins after the initial healing period, focusing on restoring range of motion, strength, and weight-bearing. The recovery timeline for a calcaneus fracture can be prolonged, taking several months to over a year for full recovery. Patients may experience persistent stiffness, pain, or swelling, and risk developing arthritis in the subtalar joint. Returning to high-impact activities may be challenging or impossible for some.