What is a calcaneus fracture?

The calcaneus, or heel bone, may be fractured as the result of high-impact external forcing – such as a car crash or fall from height, when the body weight is placed quickly or violently on the heel bone. This type of injury can be incredibly painful and debilitating, and if left untreated may cause significant future problems. Deformity and widening of the foot may result.

Symptoms of a heel bone fracture are similar to other acute injuries of the foot and ankle: bruising, pain, swelling and difficulty walking or bearing weight may all occur. In some cases, instability or deformity may also be apparent.

How is a heel bone fracture treated?

The calcaneus (heel bone) and talus form the subtalar joint which aids the foot side to side in walking.

Among all foot fractures, calcaneus fractures are generally quite rare, accounting for fewer than one percent of all broken foot bones. Treatment for the fracture may depend on its severity, including the number of fractures, size and displacement of bone fragments, and injuries to soft tissue (cartilage surfaces) surrounding the bone.

A foot and ankle doctor at Campbell Clinic will conduct a visual examination of the injury in the office and will also order an X-ray to determine the severity of the break. An MRI or CT scan may also be necessary. For small breaks with no instability, the doctor may immobilize your foot with a cast, splint or boot. Routine follow-up visits will help determine how long immobilization is necessary, but 6-8 weeks is typical for a full recovery.

If bones have shifted (displacement), surgery may be necessary. Surgery will help return bones to their normal placement and hasten healing. Patients should be careful to remain compliant with their physicians orders to avoid complications such as infection or wound healing problems. For several days after surgery you’ll need to elevate and immobilize the foot.

A physician may use a screw fixation to return bones to their normal placement and hold them together during healing.

An open reduction and internal fixation is another approach that allows the surgeon to reduce, or reposition, the displaced bones into their normal position. This procedure requires an open incision where the bones are held together using metal plates, wires or screws.

Post-surgery, a patient will undergo physical therapy, immobilization of the foot and/or a limitation on weight bearing, and pain management through the use of anti-inflammatory medications.

Do you feel or have any of these symptoms?

• Pain around the heel
• Bruising around the heel
• Swelling just below the ankle
• Heel deformity
• Inability to put weight on the heel or walk

What is a Calcaneus Fracture?

A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. This type of fracture commonly occurs during a high-energy event—such as a car crash or a fall from a ladder—when the heel is crushed under the weight of the body. When this occurs, the heel can widen, shorten, and become deformed.

Calcaneus fractures are uncommon. Fractures of the tarsal bones account for only about 2% of all adult fractures and only half of tarsal fractures are calcaneus fractures.

Before you see a physician

This injury can sometimes be treated without surgery. However, if a serious fall or high energy impact has occurred and you suspect a possible fracture you should consult a physician immediately. These injuries can be very severe.

Reasons to see a physician and treatment options

You experience any of the following after an event where serious impact to the heel occurred.

• If you suspect a fracture of any kind
• If there is any heel deformity
• If pain has made walking not possible or caused you to limp
• If serious bruising and swelling occur

The doctor will perform X rays to see if a fracture has developed. If due to the fracture the bones have shifted out of place (displaced), a foot and ankle orthopedic surgeon (Hyperlink this to our doctors) may recommend surgery.

Anatomy

The bones of the feet are commonly divided into three parts: the hindfoot, midfoot, and forefoot. Seven bones — called tarsals — make up the hindfoot and midfoot. The calcaneus (heel bone) is the largest of the tarsal bones in the foot. It lies at the back of the foot (hindfoot) below the three bones that make up the ankle joint. These three bones are the:

• Tibia — shinbone
• Fibula—smaller bone in the lower leg
• Talus—small foot bone that works as a hinge between the tibia and the fibula

Together, the calcaneus and the talus form the subtalar joint. The subtalar joint allows side-to-side movement of the hindfoot and is especially important for balance on uneven surfaces.

Recovery and return to activity

Varies depending on the severity of the fracture as well as if the injury requires surgery.

If surgery is required

Week 0-2 Post Surgery

The foot is immobilized in the soft cast (splint), iced and elevated. Your surgeon will ask that you not place any weight on your foot (non-weight bearing). This will require the use of a wheelchair, walker, knee scooter and/or crutches. You will likely require prescription-strength pain pills. Over-the-counter laxatives and stool softeners may be required to prevent or treat constipation. Your dressing should remain clean and dry. Do not change your dressing unless instructed by your surgeon.

Week 2-6 Post Surgery

At your first post-operative visit, your doctor will remove your splint and examine your incision. Sutures may need to be removed. You will be placed either into a cast (which can’t be removed) or a removable boot. For most calcaneus fractures, your surgeon will ask that you remain non-weight-bearing until the fracture demonstrates adequate healing – as seen on subsequent x-rays. If you are placed in removable boot, your surgeon may ask that you start a gentle range-of-motion program.

Week 6-12 Post Surgery

During this time period, you are working to improve the range of motion of your foot and ankle. This may involve visits to a physical therapist combined with a home exercise program. Your surgeon may also allow you to gradually increase your weight-bearing forces. At the end of this time period, if the fracture shows evidence of solid healing, your surgeon may allow you to transition out of the boot and possibly into an ankle brace. The ankle brace will require the use of a wide, stable and comfortable shoe.

Week 12-24 Post Surgery

Once the bone has completely healed, you will begin more advanced physical therapy activities (such as walking without a limp and improving your balance and strength). You will see a gradual reduction of swelling, although expect your foot/ankle to remain swollen for many months after surgery. Full recovery from these challenging injuries often takes 12 months or more.