The calcaneus, or heel bone, is a robust yet susceptible structure. A calcaneus fracture is a serious injury that can significantly affect mobility and quality of life.
Understanding the Calcaneus and How it Fractures
The calcaneus is the largest tarsal bone, forming the rear part of the foot. It sits beneath the talus, the bone connecting the foot to the lower leg, and articulates with the cuboid bone in the midfoot. This bone supports body weight, absorbs shock during movement, and provides leverage for the calf muscles via the Achilles tendon. Its relatively thin outer layer and spongy interior make it prone to collapse and fragmentation under significant force.
Calcaneus fractures typically result from high-energy events involving axial loading, meaning force directed along the bone’s axis. Common causes include falls from height, such as from a ladder or roof, where the heel impacts the ground with immense force. Motor vehicle accidents, particularly those involving the foot being crushed, also frequently lead to these injuries. Less common causes include high-impact sports injuries or a severe ankle twist. Calcaneus fractures are categorized as intra-articular, extending into the subtalar joint, or extra-articular, not involving the joint. Intra-articular fractures are more common and generally more severe, often leading to long-term complications.
Recognizing and Confirming a Heel Fracture
A heel fracture typically causes immediate, intense pain that can radiate throughout the foot and ankle, making it difficult or impossible to bear weight. Visible signs include significant swelling and bruising around the heel and ankle, which may extend up the leg or to the sole of the foot. In severe cases, the heel’s shape may appear altered due to displaced bone fragments.
If a heel fracture is suspected, a medical professional will conduct a physical examination to assess pain, swelling, and range of motion. Imaging studies then confirm the diagnosis and evaluate the injury’s extent. X-rays are typically the initial imaging test, providing clear images of the bone and indicating fracture presence and displacement. Due to the calcaneus’s complex anatomy, a Computed Tomography (CT) scan is often performed after X-rays. A CT scan provides a more detailed, three-dimensional view of the fracture pattern and subtalar joint involvement, crucial for treatment planning.
Treatment for a Broken Heel
Treatment for a broken heel depends on the fracture’s severity, displacement, and subtalar joint involvement.
Non-surgical management is typically considered for stable, non-displaced fractures with good bone alignment. This involves immobilizing the foot with a cast or removable walking boot to allow healing. Patients are advised to keep their foot elevated, apply ice, and avoid weight-bearing for several weeks.
Surgical intervention, often involving open reduction and internal fixation (ORIF), is generally recommended for displaced or complex fractures, especially those involving the subtalar joint. The goal is to precisely realign broken bone fragments and restore the calcaneus’s original shape and anatomical angles. Surgeons make an incision, manually reposition bone pieces, and secure them with plates and screws. Surgical timing may be delayed until swelling subsides, typically 10 to 14 days after injury, to reduce complications.
Recovery and What to Expect Long-Term
Recovery from a calcaneus fracture is a prolonged process.
Following treatment, a period of non-weight-bearing is necessary, lasting 6 to 12 weeks or longer depending on fracture severity and healing progress. Patients typically use crutches or a wheelchair during this time. Gradual return to weight-bearing activities is guided by medical professionals, often based on follow-up X-rays showing adequate bone healing.
Physical therapy and rehabilitation exercises are essential components of recovery, restoring range of motion, strength, and foot and ankle function. These exercises are introduced progressively as healing allows.
Despite appropriate treatment and rehabilitation, some individuals may experience long-term complications, including chronic pain, stiffness, and subtalar joint arthritis. Changes in gait or difficulty walking on uneven surfaces can also occur. Long-term outcomes vary widely, influenced by initial fracture severity and individual factors.