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Calcaneal Fracture (Heel Fracture) – What You Should Know

Reviewed by
Dr. Kelsey Armstrong

What Is A Calcaneal Fracture?

The calcaneus, also known as the heel bone, is the largest of the tarsal bones of the foot—and because the heel bone is responsible for supporting most of the body’s weight (during normal stance), a calcaneal fracture can have serious consequences.

Calcaneal fractures are not uncommon: approximately 2 percent of all fractures involve the tarsal bones, and 60 percent of these are calcaneal fractures.

Calcaneal fractures often occur when the victim falls from a great height and lands on his or her feet.

For this reason, this type of heel fracture is also known as a “lover’s fracture,” or “Don Juan fracture,” since such an injury might be sustained by a man who jumps from a high window to escape his lover’s jealous husband.

Heel Fracture Symptoms To Watch For

The symptoms of a calcaneus fracture include:

If a heel fracture is sufficiently minor, the pain may not be severe enough to prevent the victim from walking, although he or she will almost certainly limp.

The reason for this is that when we walk, the calcaneus supports most of our weight, with some help from the Achilles tendon, which transmits force from the leg to the foot.

A heel fracture may deform the calcaneus, and if this happens, the Achilles tendon alone cannot support our weight because it cannot effectively transmit force.

What Are The Various Types of Heel Fractures?

The severity of a heel fracture is mostly determined by the amount of force that caused the injury, and there are several distinct classes of fracture:

Stable or non-displaced fracture

With this type of injury, the broken ends of the bones are correctly aligned and not separated, and the bones will generally remain in place while the break heals.

Displaced fracture

With a displaced fracture, the broken ends of the bones do not line up. Surgery is usually necessary for this type of injury.

Comminuted fracture

A comminuted fracture is one in which the bone shatters into three or more pieces.

How Did I Get a Calcaneal Fracture?

The most common causes of calcaneal fractures are falls from great heights (as noted previously) and automobile accidents.If you land on your feet in such a fall, your weight will be directed downward, and your momentum will drive your talus bone down into your calcaneus.

In a car crash, the impact often drives the heel into the talus. In some cases, when the talus is forced downward in this way, it can act like a wedge to fracture the heel bone. In either case, the resulting fracture occurs in a similar pattern.

What Are The Complications of Calcaneal Fractures?

Calcaneal fractures often cause damage to the subtalar joint, which joins the calcaneus to the talus, the small bone that connects the heel to the leg.This may cause the joint to become stiff, which in turn may affect the way you walk.

How is a Calcaneal Fracture Diagnosed?

In most cases, a calcaneal fracture will be painful enough to warrant an immediate trip to the emergency room, although some victims may delay seeking medical treatment if their injuries are less severe.

If you have fractured your calcaneus, your doctor will perform a thorough physical examination. He or she will check the good blood supply to your foot and perform tests to make sure you have not sustained nerve damage.

Your doctor will also want to examine both legs, your spine, and your pelvis in order to make sure the injury extends no further than your foot.

Imaging tests will be conducted, including foot x-rays and MRI. The MRI may be especially important if your injury is mild enough that your heel pain could mistakenly be attributed to some other cause, such as plantar fascitis.

What Do You Do For A Broken Heel?

Most calcaneus fractures cause the bones to widen, thus the goal of treatment is to your normal heel anatomy; this often requires surgery. In many cases it will be necessary to repair multiple heel fractures, and damage to the subtalar joint may also need to be addressed.

Some calcaneal fractures can be treated conservatively, without resorting to surgery. If bone has not been displaced by the fracture, it may be possible to treat your heel fracture by putting your foot in a cast or some other device to immobilize it for a period of time.

This will keep the broken pieces of bone together, allowing them to heal. The cast will remain on your foot for six to eight weeks or even longer, during which time you will not be allowed to put any weight on the injured foot.

Calcaneal fractures can sometimes be treated by manipulating the foot while the patient is under anesthesia. This is called closed reduction. (The term reduction means in this context to reposition—or reduce—the bones into their proper alignment).

If this does not achieve the desired result, then open reduction—i.e., surgery—may be necessary.

Surgical Treatment

In most cases, your doctor will want to postpone surgery until he or she has been able to bring down any swelling. This will be done by immobilizing and elevating the affected foot. Ice and anti-inflammatory drugs may also be used for this purpose. This reduces the risk of infection and increases your chances of making a complete recovery.

If you have suffered an avulsion fracture, however, your doctor may not want to wait before performing surgery.

An avulsion fracture is an uncommon but very painful type of injury in which, in the case of a heel fracture, the Achilles tendon is torn away from the bone, taking with it a piece of the calcaneus. Immediate surgery in such cases decreases the risk of further injury to the Achilles tendon.

The surgical procedures most commonly performed for calcaneal fracture are open reduction and internal fixation and percutaneous screw fixation.

In an open reduction and internal fixation, the bone fragments are repositioned so that they align properly and then are fastened together with screws and/or metal plates.

Percutaneous screw fixation is somewhat simpler. If the pieces of bone are large enough, the surgeon can push them back into place without making a large incision. Screws can be inserted into small incisions to hold the pieces of bone together.

Surgery to repair a calcaneal fracture may not be recommended in some cases:

In severe cases in which the subtalar joint is damaged, additional surgery may be necessary to repair this damage.

How Long Does It Take For A Fractured Bone To Heal?

According to Podiatry Today, calcaneal fracture is one of the most complicated injuries of the lower extremities, and satisfactory outcomes are difficult to achieve. Time it takes a broken heel to heal vary based on factors such as the severity of the break, it’s exact location, etc.

Medical References:

    The American Academy of Orthopaedic Surgeons The American Orthopaedic Foot & Ankle Society Cedars-Sinai Podiatry Today

This page was last updated on November 30th, 2015

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