Fractures of the Calcaneus (Heel Bone Fractures)
What is
the Calcaneus?
The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.
The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint. This joint is important for normal foot function.
The calcaneus is
often compared to a hard boiled egg, because it has a thin, hard shell on the
outside and softer, spongy bone on the inside. When the outer shell is broken,
the bone tends to collapse and become fragmented. For this reason, calcaneal
fractures are severe injuries. Furthermore, if the fracture involves the
joints, there is the potential for long-term consequences such as arthritis and
chronic pain.
How do
Calcaneal Fractures Occur?
Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Types
of Calcaneal Fractures
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.
·
Those caused by trauma, such as avulsion
fractures (in which a piece of bone is pulled off of the calcaneus by the
Achilles tendon or a ligament) or crush injuries resulting in multiple fracture
fragments
· Stress
fractures, caused by overuse or mild injury.
The severity and treatment of extra-articular fractures
depend on their location and size.
Signs and Symptoms
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.
The signs and symptoms of traumatic fractures may include:
·
Sudden pain in the heel and inability to bear
weight on that foot
· Bruising
of the heel and ankle
The signs and symptoms of stress fractures may include:
· Swelling
in the heel area
Diagnosis
To diagnose and evaluate a calcaneal fracture, one of the Doctors at Hosey Foot and Ankle Centers will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays. In addition, advanced imaging tests are commonly required.
To diagnose and evaluate a calcaneal fracture, one of the Doctors at Hosey Foot and Ankle Centers will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays. In addition, advanced imaging tests are commonly required.
Treatment
Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or non-surgical—for the fracture.
Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or non-surgical—for the fracture.
· Rest,
ice, compression, and elevation (R.I.C.E.) Rest (staying off the
injured foot) is needed to allow the fracture to heal. Ice reduces swelling and
pain; apply a bag of ice covered with a thin towel to the affected area.
Compression (wrapping the foot in an elastic bandage or wearing a compression
stocking) and elevation (keeping the foot even with or slightly above the heart
level) also reduce the swelling.
· Immobilization.
Sometimes the foot is placed in a cast or cast boot to keep the fractured bone
from moving. Crutches may be needed to avoid weightbearing.
For traumatic
fractures, treatment often involves surgery to reconstruct the joint, or in
severe cases, to fuse the joint. The surgeon will choose the best surgical
approach for the patient.
Rehabilitation
Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.
Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.
Complications
of Calcaneal Fractures
Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences ofcalcaneal fractures are decreased ankle motion and walking with alimp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.
Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences ofcalcaneal fractures are decreased ankle motion and walking with alimp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.
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