DOCSLIB.ORG

Fractures of the Calcaneus (Heel Bone Fractures)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fractures of the Calcaneus (Heel Bone Fractures) FRACTURES OF THE CALCANEUS (HEEL BONE FRACTURES) What is the Calcaneus? Calcaneal fractures can also occur The severity and treatment of he calcaneus, also called the heel with other types of injuries, such as extra-articular fractures depend on Tbone, is a large bone that forms an ankle sprain. A smaller number their location and size. the foundation of the rear part of the of calcaneal fractures are stress foot. The calcaneus connects with the fractures, caused by overuse or talus and cuboid bones. The connection repetitive stress on the heel bone. between the talus and calcaneus forms the subtalar joint. This joint is Types of Calcaneal Fractures Achilles important for normal foot function. Fractures of the calcaneus may or avulsion may not involve the subtalar and surrounding joints. Fractures involving the joints Tibia (intra-articular fractures) are the most Stress fracture Ankle joint Talus severe calcaneal fractures, and include Extra-articular fractures Subtalar joint damage to the cartilage (the connective Calcaneus tissue between two bones). The Signs and Symptoms outlook for recovery depends on Calcaneal fractures produce different how severely the calcaneus was signs and symptoms, depending Cuboid crushed at the time of injury. on whether they are traumatic or stress fractures. The signs and symptoms of The calcaneus is often compared traumatic fractures may include: to a hard boiled egg, because it • Sudden pain in the heel and has a thin, hard shell on the outside inability to bear weight on that foot and softer, spongy bone on the • Swelling in the heel area inside. When the outer shell is • Bruising of the heel and ankle broken, the bone tends to collapse and become fragmented. For this The signs and symptoms of stress reason, calcaneal fractures are severe fractures may include: injuries. Furthermore, if the fracture Intra-articular fractures • Generalized pain in the heel involves the joints, there is the area that usually develops slowly potential for long-term consequences Fractures that don’t involve the (over several days to weeks) such as arthritis and chronic pain. joint (extra-articular fractures) include: • Swelling in the heel area • Those caused by trauma, such How do Calcaneal as avulsion fractures (in which Diagnosis Fractures Occur? a piece of bone is pulled off of To diagnose and evaluate a calcaneal Most calcaneal fractures are the the calcaneus by the Achilles fracture, the foot and ankle surgeon result of a traumatic event—most tendon or a ligament) or crush will ask questions about how the commonly,falling from a height, injuries resulting in multiple injury occurred, examine the affected such as a ladder, or being in an fracture fragments. foot and ankle, and order x-rays. In automobile accident where the heel • Stress fractures, caused by addition, advanced imaging tests are is crushed against the floorboard. overuse or mild injury. commonly required. Treatment elevation (keeping the foot even Complications of Treatment of calcaneal fractures is with or slightly above the heart Calcaneal Fractures dictated by the type of fracture and level) also reduce the swelling. Calcaneal fractures can be serious extent of the injury.The foot and • Immobilization. Sometimes the injuries that may produce lifelong ankle surgeon will discuss with foot is placed in a cast or cast problems. Arthritis, stiffness, and the patient the best treatment— boot to keep the fractured bone pain in the joint frequently develop. whether surgical or non-surgical— from moving. Crutches may be Sometimes the fractured bone fails for the fracture. needed to avoid weightbearing. to heal in the proper position. Other For some fractures, non-surgical possible long-term consequences of treatments may be used. These For traumatic fractures, treatment calcaneal fractures are decreased include: often involves surgery to reconstruct ankle motion and walking with a • Rest, ice, compression, and the joint, or in severe cases, to fuse limp due to collapse of the heel bone elevation (R.I.C.E.) Rest (staying the joint. The surgeon will choose the and loss of length in the leg. Patients off the injured foot) is needed best surgical approach for the patient. often require additional surgery to allow the fracture to heal. and/or long term or permanent Ice reduces swelling and pain; Rehabilitation use of a brace or an orthotic device apply a bag of ice covered with Whether the treatment for a (arch support) to help manage these a thin towel to the affected area. calcaneal fracture has been surgical complications. L Compression (wrapping the foot or non-surgical, physical therapy in an elastic bandage or wearing often plays a key role in regaining a compression stocking) and strength and restoring function. ARCpodiatry.com This information has been prepared by the Consumer Education Committee of the American College of Foot and Ankle Surgeons, a professional society of 6,200 foot and ankle surgeons.Members of the College are Doctors of Podiatric Medicine who have received additional training through surgical residency programs. The mission of the College is to promote superior care of foot and ankle surgical patients through education, research and the promotion of the highest professional standards. Copyright © 2008, American College of Foot and Ankle Surgeons • www.FootPhysicians.com.
Load more

Recommended publications
  • Skeletal Foot Structure
    Foot Skeletal Structure The disarticulated bones of the left foot, from above (The talus and calcaneus remain articulated) 1 Calcaneus 2 Talus 3 Navicular 4 Medial cuneiform 5 Intermediate cuneiform 6 Lateral cuneiform 7 Cuboid 8 First metatarsal 9 Second metatarsal 10 Third metatarsal 11 Fourth metatarsal 12 Fifth metatarsal 13 Proximal phalanx of great toe 14 Distal phalanx of great toe 15 Proximal phalanx of second toe 16 Middle phalanx of second toe 17 Distal phalanx of second toe Bones of the tarsus, the back part of the foot Talus Calcaneus Navicular bone Cuboid bone Medial, intermediate and lateral cuneiform bones Bones of the metatarsus, the forepart of the foot First to fifth metatarsal bones (numbered from the medial side) Bones of the toes or digits Phalanges -- a proximal and a distal phalanx for the great toe; proximal, middle and distal phalanges for the second to fifth toes Sesamoid bones Two always present in the tendons of flexor hallucis brevis Origin and meaning of some terms associated with the foot Tibia: Latin for a flute or pipe; the shin bone has a fanciful resemblance to this wind instrument. Fibula: Latin for a pin or skewer; the long thin bone of the leg. Adjective fibular or peroneal, which is from the Greek for pin. Tarsus: Greek for a wicker frame; the basic framework for the back of the foot. Metatarsus: Greek for beyond the tarsus; the forepart of the foot. Talus (astragalus): Latin (Greek) for one of a set of dice; viewed from above the main part of the talus has a rather square appearance.
    [Show full text]
  • Skier Tibia (Leg) Fractures
    Skier Tibia (Leg) Fractures In years past, the prototypical ski fracture was sustained at the lower part of the outside of the leg in the region of the ankle. However, in the past 10 years, with the advent of the modern ski boots and improvements in binding, the most commonly seen lower leg skier fracture is the tibia (or shinbone) fracture. 10% of these fractures are associated with a collision. Thus, 90 % are associated with an isolated fall or noncontact type of injury, which is generally the result of binding malfunctions and inappropriate release. The most common mechanism leading to a tibia (leg) fracture is a forward fall. Risk factors for sustaining a skier tibia fracture include: beginners or novice skiers, less than 20 years of age, higher outdoor temperatures, and increased snow depth. Non-risk factors include ski lengths, icy conditions, and male versus female sex. The modern ski boot very closely resembles an extremely well padded short leg cast in the treatment of many orthopaedic lower extremity fractures. It of course goes to a much higher level than the former shorter boot top-level varieties. The binding release and designs have been based on the fracture strength of the adult tibia (shin) bone at the top of the modern ski boot. The treatment of most skier leg fractures includes a closed reduction and cast application for variable periods of time, with or without weight bearing allowed. However, severe misalignments of the bones can lead to later bony prominences that may be incompatible with snug, rigid, high fitting ski boots.
    [Show full text]
  • Assessment, Management and Decision Making in the Treatment Of
    Pediatric Ankle Fractures Anthony I. Riccio, MD Texas Scottish Rite Hospital for Children Update 07/2016 Pediatric Ankle Fractures The Ankle is the 2nd most Common Site of Physeal Injury in Children 10-25% of all Physeal Injuries Occur About the Ankle Pediatric Ankle Fractures Primary Concerns Are: • Anatomic Restoration of Articular Surface • Restoration of Symmetric Ankle Mortise • Preservation of Physeal Growth • Minimize Iatrogenic Physeal Injury • Avoid Fixation Across Physis in Younger Children Salter Harris Classification Prognosis and Treatment of Pediatric Ankle Fractures is Often Dictated by the Salter Harris Classification of Physeal Fractures Type I and II Fractures: Often Amenable to Closed Tx / Lower Risk of Physeal Arrest Type III and IV: More Likely to Require Operative Tx / Higher Risk of Physeal Arrest Herring JA, ed. Tachdjian’s Pediatric Orthopaedics, 5th Ed. 2014. Elsevier. Philadelphia, PA. ISOLATED DISTAL FIBULA FRACTURES Distal Fibula Fractures • The Physis is Weaker than the Lateral Ankle Ligaments – Children Often Fracture the Distal Fibula but…. – …ligamentous Injuries are Not Uncommon • Mechanism of Injury = Inversion of a Supinated Foot • SH I and II Fractures are Most Common – SH I Fractures: Average Age = 10 Years – SH II Fractures: Average Age = 12 Years Distal Fibula Fractures Lateral Ankle Tenderness SH I Distal Fibula Fracture vs. Lateral Ligamentous Injury (Sprain) Distal Fibula Fractures • Sankar et al (JPO 2008) – 37 Children – All with Open Physes, Lateral Ankle Tenderness + Normal Films – 18%: Periosteal
    [Show full text]
  • Rethinking the Evolution of the Human Foot: Insights from Experimental Research Nicholas B
    © 2018. Published by The Company of Biologists Ltd | Journal of Experimental Biology (2018) 221, jeb174425. doi:10.1242/jeb.174425 REVIEW Rethinking the evolution of the human foot: insights from experimental research Nicholas B. Holowka* and Daniel E. Lieberman* ABSTRACT presumably owing to their lack of arches and mobile midfoot joints Adaptive explanations for modern human foot anatomy have long for enhanced prehensility in arboreal locomotion (see Glossary; fascinated evolutionary biologists because of the dramatic differences Fig. 1B) (DeSilva, 2010; Elftman and Manter, 1935a). Other studies between our feet and those of our closest living relatives, the great have documented how great apes use their long toes, opposable apes. Morphological features, including hallucal opposability, toe halluces and mobile ankles for grasping arboreal supports (DeSilva, length and the longitudinal arch, have traditionally been used to 2009; Holowka et al., 2017a; Morton, 1924). These observations dichotomize human and great ape feet as being adapted for bipedal underlie what has become a consensus model of human foot walking and arboreal locomotion, respectively. However, recent evolution: that selection for bipedal walking came at the expense of biomechanical models of human foot function and experimental arboreal locomotor capabilities, resulting in a dichotomy between investigations of great ape locomotion have undermined this simple human and great ape foot anatomy and function. According to this dichotomy. Here, we review this research, focusing on the way of thinking, anatomical features of the foot characteristic of biomechanics of foot strike, push-off and elastic energy storage in great apes are assumed to represent adaptations for arboreal the foot, and show that humans and great apes share some behavior, and those unique to humans are assumed to be related underappreciated, surprising similarities in foot function, such as to bipedal walking.
    [Show full text]
  • 5Th Metatarsal Fracture
    FIFTH METATARSAL FRACTURES Todd Gothelf MD (USA), FRACS, FAAOS, Dip. ABOS Foot, Ankle, Shoulder Surgeon Orthopaedic You have been diagnosed with a fracture of the fifth metatarsal bone. Surgeons This tyPe of fracture usually occurs when the ankle suddenly rolls inward. When the ankle rolls, a tendon that is attached to the fifth metatarsal bone is J. Goldberg stretched. Because the bone is weaker than the tendon, the bone cracks first. A. Turnbull R. Pattinson A. Loefler All bones heal in a different way when they break. This is esPecially true J. Negrine of the fifth metatarsal bone. In addition, the blood suPPly varies to different I. PoPoff areas, making it a lot harder for some fractures to heal without helP. Below are D. Sher descriPtions of the main Patterns of fractures of the fifth metatarsal fractures T. Gothelf and treatments for each. Sports Physicians FIFTH METATARSAL AVULSION FRACTURE J. Best This fracture Pattern occurs at the tiP of the bone (figure 1). These M. Cusi fractures have a very high rate of healing and require little Protection. Weight P. Annett on the foot is allowed as soon as the Patient is comfortable. While crutches may helP initially, walking without them is allowed. I Prefer to Place Patients in a walking boot, as it allows for more comfortable walking and Protects the foot from further injury. RICE treatment is initiated. Pain should be exPected to diminish over the first four weeks, but may not comPletely go away for several months. Follow-uP radiographs are not necessary if the Pain resolves as exPected.
    [Show full text]
  • EM Cases Digest Vol. 1 MSK & Trauma
    THE MAGAZINE SERIES FOR ENHANCED EM LEARNING Vol. 1: MSK & Trauma Copyright © 2015 by Medicine Cases Emergency Medicine Cases by Medicine Cases is copyrighted as “All Rights Reserved”. This eBook is Creative Commons Attribution-NonCommercial- NoDerivatives 3.0 Unsupported License. Upon written request, however, we may be able to share our content with you for free in exchange for analytic data. For permission requests, write to the publisher, addressed “Attention: Permissions Coordinator,” at the address below. Medicine Cases 216 Balmoral Ave Toronto, ON, M4V 1J9 www.emergencymedicinecases.com This book has been authored with care to reflect generally accepted practices. As medicine is a rapidly changing field, new diagnostic and treatment modalities are likely to arise. It is the responsibility of the treating physician, relying on his/her experience and the knowledge of the patient, to determine the best management plan for each patient. The author(s) and publisher of this book are not responsible for errors or omissions or for any consequences from the application of the information in this book and disclaim any liability in connection with the use of this information. This book makes no guarantee with respect to the completeness or accuracy of the contents within. OUR THANKS TO... EDITORS IN CHIEF Anton Helman Taryn Lloyd PRODUCTION EDITOR Michelle Yee PRODUCTION MANAGER Garron Helman CHAPTER EDITORS Niran Argintaru Michael Misch PODCAST SUMMARY EDITORS Lucas Chartier Keerat Grewal Claire Heslop Michael Kilian PODCAST GUEST EXPERTS Andrew Arcand Natalie Mamen Brian Steinhart Mike Brzozowski Hossein Mehdian Arun Sayal Ivy Cheng Sanjay Mehta Laura Tate Walter Himmel Jonathan Pirie Rahim Valani Dave MacKinnon Jennifer Riley University of Toronto, Faculty of Medicine EM Cases is a venture of the Schwartz/ Reisman Emergency Medicine Institute.
    [Show full text]
  • Comparison of Diagnostic Accuracy of Bedside Ultrasonography and Radiography for Calcaneal Fractures in the Emergency Department
    Open Access http://jept.ir Publish Free doi 10.34172/jept.2020.36 Journal of Emergency Practice and Trauma Original Article Volume 7, Issue 1, 2021, 2020, p. 17-21 Comparison of diagnostic accuracy of bedside ultrasonography and radiography for calcaneal fractures in the emergency department Majid Zamani ID , Maliheh Mazaheri ID , Farhad Heydari* ID , Babak Masoumi ID Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Received: 1 June 2020 Abstract Accepted: 14 September 2020 Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal Published online: 24 September fractures. The aim of this study was to compare the diagnostic accuracy of US with plain 2020 radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. *Corresponding author: Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the Farhad heydari; Emergency emergency department (ED) with suspicion of traumatic calcaneus fracture following acute Medicine Specialist; Department of Emergency Medicine, Faculty blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by of Medicine, Isfahan University of emergency physicians. After that, plain radiography was performed. Furthermore, all the Medical Sciences, Isfahan, Iran patients were assessed by computed tomography (CT) scan as the gold standard. Alzahra Hospital, Sofeh Ave, Keshvari Results: Finally, 193 patients were enrolled with a mean age of 29.4 ± 15.7 years (85.5% Blvd., Isfahan, Iran. male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity Tel: +989131367643; Email: [email protected] of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray Competing interests: None.
    [Show full text]
  • Talo-Calcaneal Distraction Ilizarov Frame: an Ergonomic Method to Manage Intra-Articular Fractures of Calcaneum
    ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES Talo-calcaneal distraction Ilizarov frame: an ergonomic method to manage intra-articular fractures of calcaneum Anoop Raj Singh1, Javed Ahmad 2, Vivek Kumar Shrivastava3, Pavneesh Kumar4 1Assistant Professor, Department of Orthopedics, SMMH Medical College, Saharanpur, Uttar Pradesh, India, 2,3Assistant Professor, Department of Orthopedics, Mahamaya Rajkiya Allopathic Medical College, Ambedkar Nagar, Uttar Pradesh, India, SMMH Medical College, Saharanpur, Uttar Pradesh, India, 4Assistant Professor, Department of Orthopedics, Government Doon Medical College Dehradun, India Submission: 07-03-2021 Revision: 27-05-2021 Publication: 01-07-2021 ABSTRACT Background: Principle of distraction and an indirect reduction was used to promote healing of Access this article online fractures and adequate regeneration of cartilage at the subtalar joint. Aims and Objectives: The Website: study was aimed to elaborate and develop role of Ilizarov as an alternative biological method to manage intraarticular fracture calcaneum with minimal chances of infection. http://nepjol.info/index.php/AJMS Materials and Methods: Twenty-one patients were studied and the mean age of patients DOI: 10.3126/ajms.v12i7.35459 was 40.7 years (span: 20 to 65 years). Sanders CT classification was used to divide into E-ISSN: 2091-0576 type II, 11 (52.38%); type III, 7 (33.33%) and type IV, 3 (14.28%). The average follow-up P-ISSN: 2467-9100 was 17.2 months (range: 6 to 24 months). AOFAS scale for ankle and hindfoot was used for assessment of patients- 7 (33.33%) excellent, 7 (33.33%) good, 3 (14.28%) fair, and 4 Copyright (c) 2021 Asian Journal of (19.04%) poor results.
    [Show full text]
  • Calcaneal Fracture and Rehabilitation
    1 Calcaneal Fracture and Rehabilitation Surgical Indications and Considerations Anatomic Considerations: The calcaneus articulates with the talus superiorly at the subtalar joint. The three articulating surfaces of the subtalar joint are the: anterior, middle, and posterior facets, with the posterior facet representing the major weight-bearing surface. The subtalar joint is responsible for the majority of foot inversion/eversion (or pronation/supination). The interosseous ligament and medial, lateral, and posterior talocalcaneal ligaments provide additional support for the joint. The tibial artery, nerve, posterior tibial tendon, and flexor hallucis longus tendon are located medially to the calcaneus and are at risk for impingement with a calcaneal fracture, as are the peroneal tendons located on the lateral aspect of the calcaneus. The calcaneus serves three major functions: 1) acts as a foundation and support for the body’s weight, 2) supports the lateral column of the foot and acts as the main articulation for inversion/eversion, and 3) acts as a lever arm for the gastrocnemius muscle complex. Pathogenesis: Fractures of the calcaneal body, anterior process, sustentaculum tali, and superior tuberosity are known as extra-articular fractures and usually occur as a result of blunt force or sudden twisting. Fractures involving any of the three subtalar articulating surfaces are known as intra-articular fractures and are common results of: a fall from a height usually 6 feet or more, a motor vehicle accident (MVA), or an impact on a hard surface while running or jumping. Intra-articular fractures are commonly produced by axial loading; a combination of shearing and compression forces produce both the primary and secondary fracture lines.
    [Show full text]
  • Radiographic Evaluation of Calcaneal Fractures; to Measure Or Not to Measure T
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Erasmus University Digital Repository Radiographic evaluation of calcaneal fractures; To measure or not to measure T. Schepers, A.Z. Ginai, P.G.H. Mulder, P. Patka Skeletal Radiol 2007;36(9):847-852 Abstract Objective The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. Design Prognostic study of a retrospective cohort with concurrent follow-up. Patients A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled in three disease-specific questionnaires, graded their satisfaction and the indication for an arthrodesis was noted. Standardised radiographs were made of the previously injured side and the normal (control) side. Different angles and distances were measured on these radiographs and compared with values described in the literature. The differences in values in angles and distances between the injured and uninjured (control) foot were correlated with the outcome of the questionnaires, and the indication for an arthrodesis. Results None of the angles correlated with the disease-specific outcome scores. Of the angles only the tibiotalar angle correlated with the VAS (r=0.35, p=0.045) and only the absolute foot height correlated with the indication for an arthrodesis (odds=0.70, CI=0.50–0.99). Conclusions In this study the radiographic evaluation correlated poorly with the final outcome. Measurements on plain radiographs seem not to be useful in determining outcome after intra-articular calcaneal fractures.
    [Show full text]
  • Bones Can Tell Us More Compiled By: Nancy Volk
    Bones Can Tell Us More Compiled By: Nancy Volk Strong Bones Sometimes only a few bones are found in a location in an archeological dig. VOCABULARY A few bones can tell about the height of a person. This is possible due to the Femur ratios of the bones. It has been determined that there are relationships between the femur, tibia, humerus, and radius and a person’s height. Humerus Radius Here is a little help to identify these four bones and formulas to assist with Tibia determining the height of a person based on bone length. Humerus Femur: Humerus: The thigh is the region of the femur. The arm bone most people call the From the hip bone to the knee bone. upper arm. It is found from the elbow to the shoulder joints. Inside This Packet Radius Strong Bones 1 New York State Standards 1 Activity: Bone Relationships 2 Information for the Teacher 4 Tibia: Radius: The larger and stronger of the two bones The bone found in the forearm that New York State Standards in the leg below the knee bone. extends from the side of the elbow to Middle School In vertebrates It is recognized as the the wrist. Standard 4: Living Environment strongest weight bearing bone in the Idea 1: 1.2a, 1.2b, 1.2e, 1.2f body. Life Sciences - Post Module 3 Middle School Page 1 Activity: Bone Relationships MATERIALS NEEDED Skeleton Formulas: Tape Measure Bone relationship is represented by the following formulas: Directions and formulas P represents the person’s height. The last letter of each formula stands for the Calculator known length of the bone (femur, tibia, humerus, or radius) through measurement.
    [Show full text]
  • Normative Values for Femoral Length, Tibial Length, Andthe Femorotibial
    Article Normative Values for Femoral Length, Tibial Length, and the Femorotibial Ratio in Adults Using Standing Full-Length Radiography Stuart A Aitken MaineGeneral Medical Center, 35 Medical Center Parkway, Augusta, ME 04330, USA; [email protected] Abstract: Knowledge of the normal length and skeletal proportions of the lower limb is required as part of the evaluation of limb length discrepancy. When measuring limb length, modern standing full-length digital radiographs confer a level of clinical accuracy interchangeable with that of CT imaging. This study reports a set of normative values for lower limb length using the standing full-length radiographs of 753 patients (61% male). Lower limb length, femoral length, tibial length, and the femorotibial ratio were measured in 1077 limbs. The reliability of the measurement method was tested using the intra-class correlation (ICC) of agreement between three observers. The mean length of 1077 lower limbs was 89.0 cm (range 70.2 to 103.9 cm). Mean femoral length was 50.0 cm (39.3 to 58.4 cm) and tibial length was 39.0 cm (30.8 to 46.5 cm). The median side-to-side difference was 0.4 cm (0.2 to 0.7, max 1.8 cm) between 324 paired limbs. The mean ratio of femoral length to tibial length for the study population was 1.28:1 (range 1.16 to 1.39). A moderately strong inverse linear relationship (r = −0.35, p < 0.001, Pearson’s) was identified between tibial length and the Citation: Aitken, S.A. Normative corresponding femorotibial ratio.
    [Show full text]