A heel fracture, also known as a calcaneus fracture, involves a break in the calcaneus bone, which is the largest bone in the foot. This type of injury is considered severe because the heel bone plays a fundamental role in supporting the body’s weight, enabling walking, and absorbing impact during movement. The calcaneus forms part of the hindfoot and connects with other bones to create the subtalar joint, which is essential for foot motion and balance.
Understanding a Heel Fracture
The calcaneus is a distinctive bone, often compared to a hard-boiled egg due to its thin, hard outer shell and softer, spongy interior. When fractured from high-impact forces, the bone can collapse and fragment. These fractures are relatively uncommon, making up about 2% of all adult fractures.
Heel fractures result from significant force or trauma. Common causes include falls from a substantial height or motor vehicle accidents. Sports injuries can also lead to these fractures. Less commonly, repetitive stress, such as from long-distance running, can cause smaller breaks known as stress fractures in the calcaneus.
Recognizing a Broken Heel
A broken heel causes severe pain in the heel area. Swelling develops rapidly, affecting the entire foot and ankle. Bruising is also a common sign, sometimes extending to the sole of the foot.
Individuals with a heel fracture cannot bear weight on the injured foot. There might also be a visible deformity of the heel, such as widening or shortening, and difficulty moving the foot.
Immediate Steps After a Heel Injury
If a heel injury is suspected, avoid placing weight on the affected foot. Applying the RICE protocol—Rest, Ice, Compression, and Elevation—can help manage initial pain and swelling. Rest involves staying off the injured foot. Apply ice for 15-20 minutes to reduce swelling and pain. Use an elastic bandage for compression, and elevate the foot above heart level to reduce fluid accumulation.
Seeking urgent medical attention is necessary for proper diagnosis and treatment. Healthcare providers will perform X-rays of the foot and ankle to check for a fracture. Due to the calcaneus’s complex anatomy, a computed tomography (CT) scan is often ordered for detailed images of fracture lines and to assess injury extent, especially if a joint is involved.
Treatment and Recovery
Treatment for a calcaneus fracture depends on its severity, including subtalar joint involvement and bone displacement. Non-surgical approaches may be an option for stable, non-displaced fractures. This typically involves immobilizing the foot in a cast, splint, or removable boot for several weeks, often accompanied by crutches to ensure no weight is placed on the foot for an extended period, usually 8 to 12 weeks.
For more complex or displaced fractures, surgical intervention is generally recommended to restore the heel’s normal anatomy. Open reduction and internal fixation (ORIF) is a common surgical procedure where the bone fragments are realigned and held in place with plates and screws. This aims to reconstruct the joint surfaces and overall shape of the calcaneus.
Recovery from a heel fracture is a lengthy and demanding process, often taking several months to a year, and sometimes even longer for complete healing. The initial phase involves strict non-weight bearing, followed by gradual reintroduction of weight-bearing activities as guided by a healthcare professional and imaging results. Physical therapy is an integral part of rehabilitation, focusing on regaining strength, flexibility, and mobility in the foot and ankle.
Despite appropriate treatment, some individuals may experience long-term complications. These can include chronic pain, stiffness, and the development of arthritis in the subtalar joint due to cartilage damage. Changes in gait or persistent limping are also possible. Adherence to rehabilitation protocols is important to maximize recovery and minimize potential long-term issues.