The heel bone, known as the calcaneus, is an important bone for supporting body weight and facilitating movement. Fractures of this bone, called calcaneal fractures, are serious injuries that typically result from significant force. Though less common than other fractures, they can severely impact mobility and often require medical attention. These injuries vary from simple cracks to complex breaks, requiring appropriate care.
Recognizing the Signs of a Fractured Heel
A fractured heel presents with clear physical indicators and intense discomfort. Significant swelling around the heel and ankle is an immediate sign, developing rapidly after injury. Patients frequently observe bruising, which appears, potentially extending up the leg or into the sole of the foot. In more severe cases, the heel may exhibit a visible deformity, appearing widened or shortened.
Beyond visible changes, a fractured heel causes substantial pain. Pain is severe and localized to the heel, making it difficult to touch. Bearing weight on the affected foot is impossible due to intense pain when standing or walking. This inability to apply pressure is a strong indicator of significant injury.
How Heel Fractures Occur
Heel fractures commonly result from high-energy events that exert significant force on the foot. Frequent causes include falls from height, such as from a ladder or roof, where the body’s weight crushes the heel bone upon impact. Motor vehicle accidents are another common cause, especially when the foot is forcefully pressed against a car’s floorboard or pedal during a collision. Direct trauma to the heel, such as a crushing injury, can also lead to these fractures.
Severity and pattern vary widely depending on the force and mechanism of injury. Fractures can be simple cracks or complex, involving the bone shattering into multiple pieces. They are categorized as intra-articular (damaging joint surfaces) or extra-articular (not affecting the joint). Intra-articular fractures are more severe due to potential long-term joint complications.
The Path to Diagnosis and Treatment
Immediate medical evaluation is important if a heel fracture is suspected. Healthcare providers typically begin with a physical examination, assessing visible signs like swelling and bruising, and evaluating the patient’s ability to bear weight or move the foot. Imaging tests are then used to confirm the diagnosis and determine the extent of the injury. X-rays are usually the first step to identify the fracture, but a CT scan is often considered the most reliable tool for detailed assessment, especially for complex fractures, providing a comprehensive view of bone fragments and joint involvement.
Treatment approaches for calcaneal fractures depend on the fracture’s type and severity. Less severe fractures, where bones are not significantly displaced, may be managed non-surgically with rest, ice, compression, and elevation (RICE), along with immobilization using a cast or boot. Patients are typically advised to avoid putting weight on the foot for several weeks or months. For more complex fractures, especially those involving joint displacement or multiple bone fragments, surgical intervention is often necessary to realign bones and restore the heel’s normal anatomy. This may involve using plates and screws to hold bone pieces in place.
Navigating Recovery
Recovery from a calcaneal fracture is often a lengthy process, extending from several months to over a year, depending on injury severity and chosen treatment. A non-weight-bearing period, typically lasting 8 to 12 weeks, is common for initial healing. Physical therapy helps regain strength, flexibility, and range of motion in the foot and ankle. Early motion exercises may be encouraged as pain allows.
During recovery, individuals may face challenges such as persistent swelling, stiffness, and pain, which can last for many months. Gradually returning to weight-bearing activities is a careful process, often guided by medical imaging and physical therapy. While many individuals return to most daily activities, some may experience long-term effects, including chronic pain, stiffness, or arthritis in the subtalar joint. Despite these potential challenges, proper adherence to rehabilitation protocols can improve the long-term outlook.