Patient Education

Fractures of the Calcaneus (Heel Bone Fractures)

Description

Any time you break a bone, it’s a big deal. You know that it might need surgery, will probably require weeks or months of recovery, and you’re simply not sure if you have enough artistic friends to decorate your cast.

But calcaneal fractures are something more. While not all fractures of the heel bone are devastating, many are. Some may even require years to heal completely. If getting a little break in your arm is like rain on your parade, calcaneal fractures can be something like the rains that brought the flood (the one with the big boat full of animal pairs).

Let’s talk about the heel bone for a second. It’s one of the tarsal bones, which are the bones located toward the back of your foot. The calcaneus is positioned just below the talus (ankle bone), which connects to your leg bone. The joint between these two bones (the calcaneus and the talus) is called the subtalar joint, which is responsible for the inward and outward motion of your foot.

As you might imagine, with all that weight from the body pushing down on it, your heel bone is under a lot of pressure. Fortunately, it’s got a nice firm exterior shell and a softer, more spongy interior, which helps it absorb the shocks of daily life pretty well.

Problems with the calcaneus usually occur with some traumatic event, such as a fall from a height, a car accident, or when your bodybuilder brother is too rough when tickling your feet. These traumatic events may cause either the talus to push down into the heel bone, or the heel bone to be pushed up into the talus, which often makes the sturdy calcaneus break up into several pieces.

Conversely, you may experience a stress fracture or avulsion fracture. Stress fractures (or small cracks in the bone) usually form over time when stress is put on the bone repeatedly. Avulsion fractures happen when a tendon (such as the Achilles tendon) pulls away from the bone, and breaks off a piece of the bone with it.

When bones fracture they may be displaced (that is, they move from their original positions), or stable (they stay where they should be). You may also have an open (aka compound) fracture where the broken bone pierces skin, or a closed fracture where the skin remains intact (although soft tissues inside the skin may still experience considerable damage).

Symptoms

Your symptoms may vary depending on the type of fracture you’ve experienced. For instance, if you have a stress fracture, you’ll likely notice a gradual increase in pain in your heel area over a period of several days or weeks. Your heel may also swell up. People with stress fractures may still be able to walk on their foot, but they will likely limp.

The more traumatic calcaneal fractures generally lead to an inability to put any weight on the heel (or walk at all), swelling and bruising in the heel, and a change in the shape of the heel (deformity). Oh, and it’ll probably hurt. A lot.

Diagnosis

Your podiatrist is a whiz at figuring out foot injuries, but he or she will need as much information about your injury as possible. You’ll probably be asked questions about how you sustained your injury (even how high up you were when you fell, or what type of collision you were in), how long ago your injury occurred, and any symptoms you may be experiencing. The podiatrist will probably take a look at your foot and will very likely order some sort of imaging technology, usually X-rays, to get a look at your bones. CT scans may also be helpful, particularly if the bone has broken up into several pieces.

Treatment

Treating fractures of the heel bone usually works out well, but it’s important to realize that, in the case of some very severe injuries, a complete recovery may not be possible. However, your podiatrist will work with you to give your heel the best chance for a full recovery.

If your injury is not too severe (for instance, if you have a stress fracture or if the bones are not displaced) you may be able to get away with non-surgical treatment. Such treatment usually includes the RICE method (Rest, Ice, Compression and Elevation) and immobilization (often using a special boot or cast to keep your bones from moving around as the heel heals).

When severe breaks of the calcaneus occur (particularly when there are three or more pieces of bone involved, or when the bones have become displaced), surgery will likely be necessary. Your foot surgeon will probably use screws or a combination of plates and screws to secure the bone together in a proper position so it can heal correctly. In very severe cases, your surgeon may opt to fuse the subtalar joint (the joint between the calcaneus and the talus, remember) to avoid problems with arthritis later on.

Your surgeon may also recommend waiting a few days after your break to perform surgery. This allows time for the swelling of the tissues around the break to die down a bit, increasing the chance of a successful surgery.

Recovering from a calcaneal fracture may take some time, particularly if the fracture is very severe. Stress fractures or other minor breaks may allow weight-bearing within a few weeks. More serious fractures may need several months of being off your feet. And complete healing may take a year or two.

It is so, SO important that you follow your doctor’s post-operative instructions. For instance, if you have surgery and return to weight- bearing too soon, the hardware (screws, etc.) holding your bones together may be stressed because your bone hasn’t healed, and they’ll break. Broken screws in your bones is not a great situation. Give your bones the time they need to heal, particularly if you heal slowly (such as if you’re diabetic or have a habit of smoking). Following your podiatrist’s instructions will significantly increase the chance of a successful recovery from your injury (and surgery, if you have it). However, please remember that even when you and your doctor do everything right, some injuries are too severe to ever return fully to normal function. Physical therapy, additional surgery, or supportive devices (such as orthotics or braces) may be helpful in having a happy outcome for your heel.