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.