Many of us have some personal experience with a traumatic accident—whether it happened to us, a loved one, a fellow student, or work colleague. When your foot sustains a high-energy impact or collision, one of the most significant and debilitating potential injuries is a fracture of the calcaneus, or heel bone. Although tough on the outside, the calcaneus has a soft and spongy interior. That makes it prone to fragmentation and collapse when cracked.
Symptoms and Complications
It takes a lot of force to fracture your heel bone—think of a bad fall, auto accident, or other high-energy collision. As a result, the injury can be quite severe and debilitating, limiting or even completely impairing your ability to walk normally. Pain, bruising, and swelling are a given after a heel fracture; depending on the extent of the damage there may be a visible deformity.
A broken calcaneus can also lead to chronic heel pain and arthritis, with long-term problems lasting for many years. Possible complications include chronic discomfort, stiffness, or failure of the injury to heal in the correct position. Occasionally these complications will necessitate long-term (or permanent) aids such as braces or orthotics.
Types of Heel Fractures
Heel fractures can fall into one or more of several categories. If the bone is cracked or broken but the pieces are still in place, it’s known as a stable fracture. This is generally the best outcome and may mean you can avoid surgery. If the bone ends have been thrown out of alignment, however, the fracture is said to be displaced and typically requires surgery to put the bones back in order. Comminuted fractures, in which the bone has shattered into several pieces, are highly unstable and can be very painful—open fractures (where bone has broken through the skin) are the most traumatic. The ankle joint may or may not be involved in a fracture, and more significant breaks (especially open fractures) may damage nerves, muscles, ligaments, tendons, and other tissues.
Selecting the Right Treatment
If you’ve been involved in a collision and are unable to put weight on your foot, or you have significant heel pain or swelling, follow the RICE method (rest, ice, compression, and elevation) for post-injury care and visit Family Foot and Ankle Center as soon as possible. Based on a physical examination and an X-ray and/or other imaging tests, we can determine the extent of the damage and start developing the appropriate treatment plan.
If the fracture is relatively minor and stable, a broken calcaneus may be treated non-surgically with RICE therapy and immobilization (typically a cast or surgical boot). For more complicated, displaced, or severe breaks, surgery is usually recommended. The exact procedure, as well as timing, will be selected on a case-by-case basis—often it’s best to wait until swelling has subsided before operating, provided the skin has not been broken (open fractures require immediate surgery).
It takes time to fully return to normal activity after a heel fracture, whether corrective measures are surgical or not. It may take 2-3 months, or more, before you can begin to bear weight on the affected foot, and even then you may need a period of time walking with a cane. It’s important to follow care instructions completely—you don’t want to push the bone out of place or break any plates or screws used to hold the calcaneus together.
Once you’re healthy enough, a physical therapy program will be needed to improve range of motion and strengthen stabilizing muscles in your foot, ankle, and calf. This may be painful at first, but it’s necessary to regain as much function as possible.
Unfortunately, severe heel fractures may take 1-2 years to recover completely, or in some cases may never fully return to previous levels of function. Post-recovery problems such as persistent heel pain, altered gait, or limited range of motion may need to be addressed by another surgery (possibly even fusion of the calcaneus and talus bones) or with assistive technologies such as custom orthotics or shoe modifications.
Because heel fractures are such devastating injuries with long-term consequences, you want to receive care only from the very best. Trust your feet to Family Foot and Ankle Center—our experts provide thorough care using the best available technology. Give us a call at (513) 728-4800 or (859) 282-1572 today.