Calcaneus Fractures

Fractures of the heel bone, or calcaneus, can be disabling injuries. They most often occur during high-energy collisions — such as a fall from height or a motor vehicle crash. Because of this, calcaneus fractures are often severe and may result in long-term problems. The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures. The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus. Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces.

Types of Fractures

The severity of a fracture usually depends on the amount of force that caused the break. There are many types of calcaneus fractures, including:

Stable fracture. This type of fracture is nondisplaced. The broken ends of the bones meet up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing.

Displaced fracture. When a bone breaks and is displaced, the broken ends are separated and do not line up. This type of fracture often requires surgery to put the pieces back together.

Open fracture. Broken bones that break through the skin are called open, or compound. These types of injuries often involve much more damage to the surrounding muscles, tendons, and ligaments. Open fractures have a higher risk for complications and take a longer time to heal.

Closed fracture. With this injury, the broken bones do not break the skin. Although the skin is not broken, internal soft tissues can still be badly damaged.

Comminuted fracture. This type of break is very unstable. The bone shatters into three or more pieces.

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

If the pieces of broken bone have not been displaced by the force of the injury, you may not need surgery. Casting or some other form of immobilization may be an option. This will keep the broken ends in proper position while they heal.

You will not be able to put any weight on your foot until the bone is completely healed. This may take 6 to 8 weeks, and perhaps longer.

If the bones have shifted out of place (displaced), you may need surgery.

If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your leg immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.

This waiting period before the operation often improves your overall recovery from surgery and decreases your risk of infection.

Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery.

Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon tears away from the bone (avulsion). For this type of fracture, early surgery can decrease the risk of injury to the skin around the Achilles tendon.

The following procedures are used for various types of calcaneus fractures.

Open Reduction and Internal Fixation

During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws or metal plates and screws.

Percutaneous Screw Fixation

Sometimes, if the bone pieces are large, they can be moved back into place by either pushing or pulling on them without making a large incision. Special screws can be placed through small incisions to hold your bone pieces together.