Calcaneus fractures, commonly known as broken heel bones, are serious injuries that significantly affect mobility and long-term foot function. The calcaneus is the largest bone in the foot and a major component of the hindfoot, responsible for absorbing the impact of walking and running. Because this bone is designed to withstand substantial forces, a fracture typically results from a high-energy event. Understanding the nature of this injury and the expected path to recovery is important for those dealing with a heel fracture.
Understanding the Calcaneus Fracture
The calcaneus is the largest of the seven tarsal bones, forming the bony prominence of the heel. Its primary function is to transfer weight-bearing forces from the leg to the ground, serving as a crucial lever arm for the calf muscles via the Achilles tendon. The shape of the calcaneus is fundamental to the biomechanics of the foot, helping to support the foot’s longitudinal arch.
Fractures most frequently result from a forceful impact that drives the talus, the ankle bone situated above the calcaneus, down into the heel bone. This mechanism, known as axial loading, commonly occurs in scenarios like falls from a significant height or motor vehicle accidents. The severity and location of the break determine the fracture classification.
Calcaneus fractures are categorized based on whether they involve the subtalar joint, which sits just below the ankle joint. Extra-articular fractures, accounting for about 25% of cases, occur outside the subtalar joint and are generally less complex. Intra-articular fractures, making up the remaining 75%, involve the joint surface and are associated with greater challenges due to the disruption of the smooth cartilage needed for movement. Involvement of the joint surface directly influences the chosen treatment and the long-term prognosis.
Diagnosis and Treatment Pathways
Diagnosis begins with standard X-rays, which reveal the fracture and the degree of heel bone collapse. A specific measurement on the lateral X-ray, called Bohler’s angle, assesses the integrity of the heel’s structure. A normal Bohler’s angle ranges from 20 to 40 degrees; a measurement below this range suggests a collapse of the heel bone due to the fracture.
The definitive tool for evaluating the injury and planning treatment is a Computed Tomography (CT) scan. The CT scan provides a detailed, three-dimensional view of the bone fragments and the extent of damage to the subtalar joint surfaces. This visualization allows orthopedic surgeons to classify the fracture precisely, often using the Sanders classification system for intra-articular injuries.
Treatment pathways diverge based on the fracture’s severity and displacement. Non-surgical management, involving immobilization with a cast or boot and no weight-bearing, is appropriate for non-displaced fractures and most extra-articular breaks. This conservative approach relies on the bones healing in their correct position without surgical intervention.
Surgical management, most often involving an Open Reduction Internal Fixation (ORIF), is reserved for displaced intra-articular fractures. The goal of this procedure is to physically open the area, realign the fragmented bone pieces, and hold them in place with plates and screws. The primary objective is to restore the normal shape and height of the calcaneus and achieve the smoothest possible joint surface to prevent future arthritis. Surgery may be delayed for 7 to 10 days until initial severe swelling of the soft tissues has subsided.
Navigating the Recovery Timeline
Recovery from a calcaneus fracture is a protracted process, characterized by a significant period of non-weight bearing, regardless of the treatment method. Patients are strictly prohibited from putting weight on the injured foot for an extended period, typically ranging from eight to twelve weeks. This period allows the complex bone structure to heal without the stress of body weight, which can cause the fragments to shift.
Physical therapy begins during the non-weight-bearing phase, focusing initially on gentle range-of-motion exercises for the ankle and surrounding joints to prevent stiffness. Once the surgeon approves partial weight-bearing, therapy intensifies to include gait training and exercises to slowly increase the load on the foot. The goal of this phase is to gradually reintroduce the foot to the mechanics of walking and strengthen atrophied muscles.
Long-term outcomes often involve managing complications, with stiffness in the subtalar joint being common. Post-traumatic arthritis, especially after intra-articular fractures, is a frequent long-term concern, as the joint surface may never perfectly recover its original smoothness. Patients may also experience chronic pain or a widening of the heel, which can make shoe fitting difficult. A return to full, unrestricted activity, including sports or physically demanding work, often takes anywhere from nine to eighteen months.