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Recovery Guide: Calcaneal Fracture

What Is It?

The calcaneus is the bone that makes up your heel. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. This is usually related to the amount of force that was used to cause the break. The worst case scenario is that the calcaneus shatters resulting in many fragments. This is known as a comminuted fracture (a break that results in three or more fragments). Because calcaneal fractures are usually the result of a high-force impact, there is a chance that the bones can damage soft tissue and puncture the skin as well.

Calcaneus_Fracture

Breaks of the calcaneus can be very serious since they can affect the subtalar joint; the joint that is comprised of the calcaneus and the talus (the ankle bone). This joint is responsible for the side-to-side motion of your foot.  Therefore, a severe break in the calcaneus can also result in a stiff ankle, limiting movement. In addition, the calcaneus is also where the Achilles tendon joins from the calf muscle. Tendons are connective tissue that connects muscle to bone and allows us to perform our movements. The Achilles tendon allows us to point our foot down when walking and running. It also helps our heel to support our body weight. A fracture in the calcaneus can disrupt the union of the heel and the Achilles tendon, thus destabilizing our foot and ankle. Lastly, since it typically takes a lot of force to break the calcaneus, other bones in the foot and ankle can be broken as well. All of these features can attribute to instability, swelling, and pain. If a fracture is really severe, it might limit or prevent the patient from walking or even weight bearing all together.

Treatment Options

Calcaneal fractures that present with a displacement of bone can result in the formation of deformity if not properly realigned. The bone also risks not healing altogether if not taken care of. Therefore displacement fractures or fractures that result in many broken fragments (such as comminuted fractures) are treated operatively. Surgery will require internal fixation, such as the use of plates, nails, and screws to realign the bone and fix them in place. Any damaged tissues will be fixed, such as reattachment of ligaments or the Achilles tendon, if separated. The difference between conservative and surgical treatments all depend if there is any displacement of bone or not. If the bones look intact and the soft tissues are relatively undamaged, then casting and immobilization will be the primary means of treatment. Any fracture that results in puncturing of the skin will require immediate surgery to clean and sterilize the wound. Calcaneal fractures that result in an avulsion of the Achilles tendon (the bone that connects with the Achilles tendon breaks away and detaching it from the main body) would also require immediate surgery to reattach the tendon. A non-weight bearing scooter is almost always recommended.

Prognosis

Because they can be pretty severe, breaks of the calcaneus take quite a bit of time to heal. Recovery time is about the same for conservative and surgical patients.  It takes about 10 to 12 weeks for the bone to fully heal. During this time period patients will be expected to be non-weight bearing. This is followed by a period where the patient will transition from partial to full weight bearing. Physical therapy is key because the subtalar joint will be stiff and will need to be conditioned back into mobility. After about 4-6 months patients will start seeing some real progress, though it could take up to a year or a year and a half to achieve maximum recovery. However, there is no guarantee that patients will achieve the same status that they were in prior to injury.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Sources

1.)   http://www.hss.edu/condition-list_foot-ankle.asp

2.)   http://www.footeducation.com/foot-and-ankle-conditions

3.)   http://orthoinfo.aaos.org/menus/foot.cfm

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