Calcaneus Fractures

The calcaneus bone is located in the heel and makes up the entirety of the heel. This bone supports the foot and helps us walk normally. There is a joint on top of the calcaneus. This is what allows the foot to rotate outwards and inwards.

Calcaneus fractures occur as a result of a high energy injury, such as a front end traffic crash or as a result from a large height, such as a fall from a ladder or roof. Sometimes sports injuries can cause calcaneal fractures. The calcaneus can develop a stress fracture, especially in long distance runners. These are different fractures from traumatic calcaneal fractures.

The symptoms of a calcaneus fracture include a large amount of swelling and pain in the heel along with inability to walk, and bruising of the foot. The pain in the heel can be very severe. Fortunately, most calcaneal fractures are closed fractures. In rare cases, the fracture can be compound or an “open” fracture. This is considered an injury requiring emergency surgery.

Calcaneal fractures can be treated in a conservative manner by using casts for up to six weeks. Some calcaneal fractures need surgical intervention. It depends on whether or not the calcaneal fracture is in place or not. It is not recommended to do surgery if the patient has peripheral vascular disease or diabetes. Smokers also do poorly with surgery on the calcaneus.

In surgical repair, incisions are made on the outside of the heel. Placing a metal plate and screws into the heel bone, the normal alignment of the heel is performed. No plate is necessary if the calcaneus is broken in just two big chunks as opposed to many fragments. In severe calcaneal fractures, the bone is fused to the tibia, thus freezing the joint but allowing the foot to be stable enough for walking.

Because the calcaneus fracture is a high impact injury, the patient needs to be evaluated for other high energy injuries, such as lumbar fractures. In 10-15 percent of those who suffer calcaneus fractures, also suffered head, neck and other extremity fractures. Calcaneal injuries are generally considered severe and lead to long term foot problems and ankle problems. Early complications can be surgical in nature, such as with poor circulation in peripheral vascular disease, smoking, and diabetes. There can be loss of the foot or part of the foot and nonunion of the fracture due to poor circulation.

The late complications of a fracture of the calcaneus include chronic foot pain and arthritis of the foot. In fact, the risk of arthritis after the calcaneus is fractured is quite high. Certain footwear just can’t be used after a calcaneus fracture. Walking, running and standing for long periods of time also cannot be tolerated after a calcaneus fracture.

Patients may need to be off the affected foot for about six weeks to three months. Swelling and bruising need to be controlled with elevation of the foot and proper compression of the heel. Ice to the affected area is important to use. Prolonged disability is not uncommon after calcaneal fractures.

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