A calcaneus fracture is a break in the heel bone. There are two types of calcaneus fractures: those involving the subtalar joint and those not involving the joint.

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The subtalar joint, formed by the calcaneus and the bone above it (the talus), allows side-to-side motion of the foot, crucial for walking on uneven surfaces. Fractures involving the subtalar joint are typically the most severe.

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Symptoms

Symptoms of a heel fracture include pain, swelling, and bruising of the heel. Patients often find it difficult or impossible to walk. Severe swelling may lead to blisters around the foot and heel.

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Causes

Fractures involving the subtalar joint usually result from high-energy injuries such as falls from height or car accidents. Low-energy injuries, like twisting the ankle, may cause smaller bone fragments or chips to break off from the edges of the calcaneus, known as avulsion fractures, which typically do not involve the joint surfaces.

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Diagnosis

Dr. Kamel  will typically use X-rays and a physical examination to diagnose calcaneus fractures. In some cases, a CT scan may be necessary for a closer examination of the broken bone pieces or to visualize aspects not visible on X-rays.

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Treatments

Some heel fractures can be managed without surgery. The foot may be placed in a splint or removable fracture boot to allow for ankle and foot motion. The duration of non-weightbearing depends on the severity of the fracture.

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Surgery may be recommended if the fracture involves the joint and pieces are displaced. Dr. Kamel may use plates and/or screws to hold the fracture pieces in place. In severe cases, fusion of the subtalar joint may be recommended simultaneously with calcaneus fracture repair to mitigate the risk of arthritis.

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Recovery

Recovery from a calcaneus fracture can be protracted, with a non-weight bearing period lasting 8-12 weeks. Physical therapy can aid in motion and improve foot function. Pain, stiffness, and swelling may persist for months or indefinitely, depending on the severity of the injury. Most individuals can return to work and recreational activities after complete recovery.

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Risks and Complications

Healing of the surgical incision may pose challenges, with issues typically resolving with local wound care. However, deep infections may occur, necessitating further surgical intervention. Permanent stiffness of the subtalar joint can occur, limiting foot side-to-side motion. Fractures involving the subtalar joint may lead to arthritis over time, which can be managed with injections, bracing, or surgical fusion.

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Calcaneus fractures may cause heel widening, making shoe fitting difficult, a condition treatable with surgery. Additionally, damage or irritation to tendons passing along the outside of the heel bone may occur, which can be managed with bracing or surgery.