Foot and Ankle Surgery

Calcaneal (heel bone) fractures

calcaneus fracture

Calcaneal fracture

Calcaneus,  heel bone,  is  contact the point of the body with the ground.  Talus articulating with distal tibia in the upper surface sits on the calcaneus. Calcaneus is the first bone of the body exposed to direct trauma in high energy  falls off high.Therefore, calcaneal fractures are the most common fractures occurring following falls from high altitude. Heel bone fracture is also seen with motor vehicle accidents, sports injuries and high-energy trauma, such as gunshot wounds.

In addition, calcaneal stress fractures can be seen with increased activity in long-distance runners, novice soldiers, and beginner sportsmen.

What are the clinical findings of calcaneus fracture ?

Severe heel pain, swelling, bruising and being unable to bear weight on foot and unable to walk are the most common complaints.

How is the diagnosis of fractures of the calcaneus made ?

calcaneus fracture

calcaneus fracture radiography

Fractures of the calcaneus can be diagnosed with plain radiographs in most of he cases.In order to make a proper treatment plan, fractures of the calcaneus should be evaluated by computed tomography. MR is helpful in the cases of  stress fracture, bone contusion which cannot be diagnosed on plain x-rays.

What is the treatment of calcaneal fracture ?

Before planning any treatment, one should evaluate whether fracture extends to the joint line. If the fracture line extends to joint line, displaced fractures will cause pain and difficulty in walking on uneven surfaces in follow-up. If the orthopedic surgeon believes that joint surface can be restored with surgery, open surgery should be performed. In some cases, orthopedic surgeon may believe that surgery may not make a contribution. In this cases, calcaneal fractures may well be treated conservatively. Most of this type of severe articular fractures require subtalar arthrodesis in long term following both surgical and conservative treatment.

Undisplaced extra-articular calcaneal fractures is treated with non weight bearing cast for 4-6 weeks. After then, patients may be allowed to weight bear in an orthoses depending on their radiological and clinical healing level. Displaced non articular calcaneal fractures may be treated with closed reduction and percutaneous internal fixation or open reduction and internal fixation.

 

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About the author

Prof.Dr. Seref Aktas