What is a calcaneal fracture?
The calcaneus is also known as the heel bone. In addition to being a the attachment site for the Achilles tendon in back and the plantar fascia on the bottom, it is also the weight bearing bone in the back of the sole and the back portion of the arch. It is the hard bone that is on the back third of the lateral portion of the foot. It also makes a joint with the talus or ankle bone called the subtalar joint. This joint allows you to twist your heel inward and outward. This action allows your foot to adjust to uneven surfaces such as when you walk on a roof with a pitch or in the lumpy grass.
A calcaneus fracture crushes the heel, leading to widening of the heel and joint damage.
The injury that causes a calcaneus fracture is a fall from a height, even as little as a few feet. What happens is that the inside portion of the calcaneus shears away from the body of the heel under the force of the talus (1) and jams down the inside portion of the subtalar joint into the body of the calcaneus. The body of the calcaneus then breaks away from the rest of the front of the foot and rotates. This is the most common pattern. What results is that the joint is crushed and irregular, the
- Graphic of major fractures and forces involved in a calcaneal fracture
back of the heel rotates, and widens. The irregular joint often becomes arthritic and/or stiff.
What do I do about it?
See a doctor immediately. While, even when displaced and requiring surgery, surgery is often delayed, it is a good idea to get together with a surgeon who is experienced in treating these injuries.
What else could it be?
Other problems that could give pain in the same area are:
- Ankle sprain
- Ankle fracture
- Other types of smaller talus and calcaneus fractures
- Midfoot fractures and dislocations
- Subtalar and ankle dislocations
- Talar neck fractures and fracture/dislocations
What can I expect?
The choice between an operation and non-operative treatment is based on whether the surgery is worse than the possibility of leaving the fracture in its original position. There are several alternative that your doctor has to choose from and requires a doctor who is up-to-date on the current thought, and techniques that are available. Most treatment is directed toward realigning the joint so that it functions as well as possible. Serious consideration should be given to the condition of the skin, other medical problems such as smoking, poor arterial supply, and diabetes as all of these conditons may make you more prone to infections or wound breakdowns.
If it is treated without an operation, it is likely that your doctor will immobilize the fracture in a cast or a cast boot. You will need to stay off of the foot for 4-8 weeks. It will swell for 4 months or more.
Usually an injury of this magnitude affects the foot in significant way. It is likely that the foot will be stiffer, more swollen, and possibly persistently painful in some way despite treatment.