When it comes to foot, ankle, and heel issues, they can have serious negative effects on a person’s daily activities. Since our feet provide the foundation for the rest of our bodies, we must ensure that any problems are treated by a podiatrist.
In certain circumstances, patients may have to deal with even more severe issues with the foot, ankle, and other podiatric areas. One of these types of serious conditions is a calcaneal fracture.
Before discussing what calcaneal fractures are, we must first understand a bit about the anatomical makeup of the foot area. The foot is divided into three general regions – hindfoot, midfoot, and forefoot – and the tarsals are seven bones that make up the hindfoot and midfoot. The calcaneus is the largest of these tarsal bones, and, together with the talus (one of three bones comprising the ankle joint), forms the subtalar joint. This joint is responsible for the side-to-side movement of the hindfoot and balancing on uneven surfaces.
Fractures of the calcaneus (heel bone) can be extremely painful and even disabling if not treated properly. Depending on the circumstances, calcaneal fractures can cause the heel bone to widen and shorten, and some fractures may even affect the subtalar joint. When bone fractures cross the surface of the joint, this is known as displaced intraarticular calcaneal fractures. These displaced intraarticular fractures can create chronic pain, arthritis, and loss of motion. Podiatrists have separated the fractures into different classifications, including the Essex-Lopresti classification which accounts for the severity of the degree of joint involvement and displacement of the bones.
Calcaneal fractures are quite common when it comes to issues with the tarsal bones. A small percentage of fractures in adult patients are actually calcaneus fractures (though they are common in tarsal injuries) of any type including intraarticular calcaneal fractures or extra-articular fractures.
Likewise, the severity of a calcaneus fracture will depend on a variety of different factors such as the:
It is important for any patient who may have sustained a problem severe enough to cause a calcaneus fracture to seek immediate medical attention from a foot and ankle specialist so that the fracture does not prevent the ability of the foot to be weight-bearing.
In general, a calcaneus fracture requires serious and extreme circumstances to actually occur. There are many different ways for a fracture to occur – even a simple twist of the ankle while walking or running can result in a serious fracture. Head-on auto accidents often cause the type of trauma that results in comminuted fractures (the bone is shattered). However, a calcaneus fracture usually requires some type of severe impact to cause this type of orthopedic trauma.
The most common circumstances whose outcome is a calcaneus fracture are falling from a height, motor vehicle collisions, and severe twisting of the ankle. Primarily, the classification of this fracture type depends on the amount of impact placed on the foot and if the heel is impacted as well. For example, falling from the roof and landing on your feet could drive the talus bone into the heel, causing the fracture. The greater the impact, the more severe the damage to the heel.
If you have sustained an injury that you believe has impacted the heel, you may experience any of the following symptoms:
Minor fractures of the heel may not prevent you from walking because the Achilles tendon acts through the heel to support you. Even with your body making this compromise, though, you will likely still feel unstable and walk unnaturally. You must receive medical attention for the injury and have an expert podiatrist determine if nonoperative treatment is possible or if it requires a surgical approach.
After examining your foot and ankle as well as taking x-rays and/or CT scans to review the extent of the fracture lines and to see if the bones are displaced (extra or intra articular calcaneal fracture), your doctor can develop a thorough treatment plan which will consider operative versus non-operative options for the management of pain and getting your ankle back into the proper shape. He or she may use Bohler’s angle and the angle of Gissane to help determine the seriousness of the injury.
When heel fractures occur, the bone widens and shortens, in general. Surgical treatment, then, is usually required to restore the heel and give patients the best possible outcome with the lowest potential for complications.
If your fracture simply broke the bone and did not displace the pieces through the force of the accident, you may be a candidate for non-surgical treatment. This usually involves immobilization using a cast, splint, or brace for 6-8 weeks, possibly longer. Bearing weight on the ankle is not recommended, and you may still need pain management or physical therapy even after the bone has healed.
Operative options are recommended for patients if the bones have been displaced and other parts of the anatomy such as soft tissues and muscles are at risk. If your skin was not broken during the accident, your doctor may wait to perform surgery until the swelling has reduced. Open fractures, though, are exposed to the environment and need to be treated as soon as possible.
Depending on the classification of the heel bone (os calcis) fractures, your doctor may opt for one of a variety of operative treatment procedures. These include percutaneous screw fixation and open reduction/internal fixation. In the open reduction and internal fixation option, you will have a large incision made to reposition the bones rather than only a small incision to insert screws as in the first surgery option.
Post-operative recovery will generally include pain management and rehabilitation to ensure the best possible outcomes, return of full range of motion, and no complications from the surgery with the soft tissue, muscles, or tendons.
If you have been in an accident and the angle of the collision caused issues with your heel bone, our podiatric surgeons are here to help you recover. Our treatments can take care of all types of breaks (type i fractures, type ii fractures, type iii fractures, and type iv fractures), and we are happy to discuss the procedures with you. Contact Rogers Foot & Ankle Institute today to schedule an appointment with our expert podiatrists!