A broken heel is medically known as a calcaneal fracture. The calcaneus, or heel bone, is the largest bone in the foot and supports body weight while absorbing shock during movement. Due to its function, a fracture is typically a serious injury that significantly impacts mobility and long-term quality of life. The severity of the injury often relates directly to the force involved, leading to a complex healing and recovery process.
Mechanisms of Injury
A broken heel bone usually results from high-energy trauma that crushes the bone. The most common cause is a fall from a significant height, such as a ladder or roof, where the person lands directly on their feet. The body’s weight transmits force straight down the leg, driving the talus bone into the calcaneus below it.
Motor vehicle accidents also frequently cause these injuries, often when the heel is forcefully driven into the floorboard during a collision. This impact creates an axial loading force, compressing the calcaneus. Intense pressure can cause the bone to shatter, resulting in a comminuted fracture.
The fracture pattern depends on how the force travels through the foot. The talus can act as a wedge, splitting the calcaneus and often involving the subtalar joint, located directly below the ankle. Fractures involving this joint, known as intra-articular fractures, account for most calcaneal breaks and carry a higher risk for long-term complications. Less commonly, repetitive stress from activities like long-distance running can cause a calcaneal stress fracture, which is a small crack.
Symptoms and Immediate Steps
The primary symptom of a calcaneal fracture is severe pain in the heel, making it impossible to bear weight, walk, or stand. Rapid and significant swelling of the heel and ankle is a hallmark sign, often appearing quickly after the injury.
Bruising is also prominent, visible around the heel and ankle, sometimes extending to the sole of the foot. In severe cases, the heel may visibly appear wider or shorter than the uninjured foot due to the collapse and displacement of bone fragments. If a broken heel is suspected, do not attempt to put any weight on the foot or move it.
Immediate first aid involves the RICE protocol: Rest, Ice, Compression, and Elevation. The foot should be kept elevated above the heart level to reduce swelling, and ice can be applied for short periods. Seek professional medical evaluation immediately by contacting emergency services or going to an emergency room. Attempting to walk on a broken calcaneus can worsen displacement and increase the risk of serious complications.
Medical Treatment Approaches
Diagnosis begins with an examination, followed by X-rays and a Computed Tomography (CT) scan. The CT scan is important because it provides a detailed, three-dimensional view of the bone and the subtalar joint involvement, which guides treatment. Treatment pathways depend on whether the fracture is displaced and if the subtalar joint is affected.
Non-Surgical Management
Non-surgical management is appropriate for stable, non-displaced fractures or those with minimal joint surface damage. This conservative approach involves immobilizing the foot in a cast, splint, or boot for six to eight weeks. Patients must adhere to a strict non-weight-bearing protocol during immobilization to allow natural healing. Pain management and diligent elevation are priorities during this initial phase.
Surgical Management
Surgery is generally necessary for displaced fractures, especially those involving the subtalar joint, or when the bone is significantly crushed and widened. The goal is to restore the normal anatomy of the heel bone and the joint surface. The most common procedure is Open Reduction and Internal Fixation (ORIF).
During ORIF, the surgeon makes an incision to manually realign the bone fragments. These fragments are then held securely in place using metal plates and screws to stabilize the repair. Surgery is often delayed until initial swelling subsides, which reduces the risk of wound complications. While surgery carries a higher risk of immediate complications, it may lead to better long-term functional results for specific fracture types.
Rehabilitation and Long-Term Outlook
Recovery from a calcaneal fracture is a lengthy process. Following treatment, the patient must adhere to a strict non-weight-bearing period, typically lasting six to twelve weeks. This initial phase is crucial for bone healing and protecting any surgical repairs.
Once imaging confirms sufficient healing, a physical therapist guides the patient through a gradual return to weight bearing. This process starts slowly, often using crutches or a walking boot, and progresses over several weeks. Intensive physical therapy is necessary to address stiffness and weakness developed during immobilization. Exercises focus on regaining full range of motion, improving muscle strength, and correcting the gait pattern.
The full recovery timeline, from injury to a return to normal activities, can range from three months to over a year, depending on the fracture severity. Despite successful treatment, a calcaneal fracture carries a risk of long-term complications. The most notable is the development of post-traumatic arthritis in the subtalar joint, which causes chronic pain and stiffness, especially when walking on uneven surfaces. Other potential long-term issues include:
- Chronic pain.
- A persistent limp.
- Difficulty returning to high-impact activities such as running or jumping.