The calcaneus, commonly known as the heel bone, is the largest of the seven tarsal bones in the foot and forms the foundation of the rear part of the foot. Fractures of the calcaneus are relatively uncommon, accounting for only about two percent of all adult fractures. Most fractures result from high-energy events like a fall from a substantial height or a motor vehicle accident, where the foot is subjected to significant axial loading. Recognizing the immediate presentation of this injury helps in assessing its severity and seeking appropriate medical attention quickly.
Identifying the Immediate Physical Signs
The most noticeable sign of a traumatic heel fracture is the onset of sudden, intense pain localized directly in the heel. The pain prevents the individual from putting any weight on the injured foot, making walking or standing nearly impossible. The injury causes rapid and substantial swelling around the heel and ankle.
The swelling often distorts the normal contour of the heel, sometimes making the heel appear wider or shorter than the uninjured foot. Bruising develops quickly and can be extensive, spreading beyond the immediate heel area. It is not unusual for the bruising to extend up the ankle and visibly affect the sole of the foot.
In more severe cases, the injury may cause a visible deformity of the heel itself. The calcaneus has a thin, hard shell surrounding a softer, spongy interior, which means high-impact forces can cause the bone to collapse and fragment, leading to the distortion of the foot’s structure. Any attempt to move the foot may be met with sharp, debilitating pain due to the instability of the bone fragments.
Understanding Different Types of Heel Fractures
Not all heel fractures present with the same dramatic visual signs, as the appearance is dependent on the fracture’s pattern and severity. The mechanism of injury, usually an axial load, determines the fracture type, which can range from minor cracks to severe fragmentation. These injuries are often categorized by whether they involve the joint surface, which is a major factor in the long-term prognosis.
A distinction is made between extra-articular and intra-articular fractures. Extra-articular fractures occur outside the subtalar joint and tend to be less complex. Conversely, intra-articular fractures extend into the subtalar joint, damaging the cartilage surface and increasing the risk of long-term joint problems. Approximately 75% of calcaneal fractures are intra-articular.
Within these types, fractures are also classified by displacement. A non-displaced fracture involves a break where the bone fragments remain relatively well-aligned, often resulting in less visible deformity and potentially less extreme pain. Displaced or comminuted fractures are those where the bone fragments have shifted significantly or shattered into multiple pieces. These latter types account for the most dramatic presentations, including pronounced swelling and obvious heel widening.
Seeking Medical Confirmation and Care
When a calcaneal fracture is suspected, the first action should be to immediately stop bearing weight on the affected foot and seek emergency medical evaluation. Immobilizing the foot and elevating it above the level of the heart can help reduce the rapid swelling that occurs. Self-diagnosis is not possible because the true extent of the internal damage must be assessed by a professional.
Diagnosis relies on medical imaging to confirm the break and evaluate its complexity. The initial imaging study is typically a series of X-rays, which can visualize the fracture and determine if the bone pieces are displaced. Following the X-ray, a Computed Tomography (CT) scan is often required, as it provides a three-dimensional view of the bone. The CT scan is necessary to accurately assess subtalar joint involvement and the exact number and location of bone fragments for surgical planning. Treatment is based on these results: non-displaced fractures are managed non-surgically with casting, while displaced fractures often require surgery to realign the bone and restore the heel’s anatomy.