The calcaneus is otherwise known as the heel bone, the largest bone in the foot that forms the foundation of the hind foot. The calcaneus connects to the talus and cuboid bones. The attachment of the talus and calcaneus forms the subtalar joint, important for normal foot function.
You can think of the calcaneus as a hard-boiled egg with a thin, hard external shell, and a soft, spongy bone within the shell. Calcaneal fractures are severe injuries because a fracture to the outer shell causes bone collapse and fragmentation. A fracture that involves the joints may produce long-term complications such as arthritis and chronic pain.
The majority of calcaneal fractures are caused by trauma, most often falling from a height such as a ladder or being in a motor vehicle accident that crushes the heel against the floorboard. Other types of injuries, such as ankle sprains may involve fractures of the calcaneus. These fractures are less often stress fractures that result from excessive use or stress on the heel bone.
Calcaneal fractures do not always involve the subtalar and surrounding joints. Intra-articular fractures, those that involve the joints, are the most severe fractures. These fractures are accompanied by damage to the cartilage – the connective tissue between two bones. Patients recover at different rates depending on the severity of calcaneal fracture at the time of injury.
Fractures that do not involve the joint are called extra-articular fractures and include:
When diagnosing a calcaneal fracture, Dr. Radovic will ask how the foot was injured, then examine the foot and ankle. X-rays and often additional imaging studies are ordered.
Non-surgical might be used for some calcaneal factures and include:
Rest, ice, compression and elevation, also known as R.I.C.E. therapy. Rest the foot to allow the fracture to heal. Apply a bag of ice covered with a thin towel to reduce pain and swelling. Compress the foot by wrapping it in an elastic bandage, or wearing a compression stocking to reduce swelling. Elevate the foot at or slightly above the heart level to reduce swelling.
Immobilize the foot by wearing a cast or a cast boot to prevent the fractured calcaneus from moving. Dr. Radovic may recommend crutches to avoid weight bearing.
Traumatic fractures often require surgery for joint reconstruction, or in severe cases, for joint fusion. Dr. Radovic will determine the most suitable surgical approach for each individual patient.
Surgical and non-surgical treatments of calcaneal fractures most often benefit from physical therapy to restore foot strength and function.
Fractures of the calcaneus are serious injuries that could result in long-term complications such as arthritis, stiffness and joint pain. Calcaneal fractures sometimes do not heal in the proper position and may also result in diminished ankle motion and decreased leg length. The heel bone may collapse, causing patients to walk with a limp. Treatments may involve additional surgery possibly in conjunction with long term or permanent use of a brace. Dr. Radovic might also recommend an orthotic device for arch support to help control these complications.