A calcaneal fracture is a fracture of the calcaneus, one of the bones in the heel. This bone is a key part of the tarsus, the collection of bones involved in the articulation of the heel, and there is a potential for serious complications with a calcaneal fracture. Treatment may be surgical or nonsurgical in nature, depending on the specifics of the case and the patient's history. An orthopedic surgeon is usually involved in evaluation and treatment of the patient and people can also see a foot and ankle specialist.
The most common cause of a calcaneal fracture is a fall, particularly onto a hard surface. The fracture can also be associated with diseases of the bone like tumors and osteoarthritis and there is also a risk of incurring this type of fracture from a twisting injury. For athletes, stress fractures of the calcaneus can occur and may cause serious problems with training.
Symptoms of a calcaneal fracture include pain, swelling, difficulty walking, and extreme tenderness. In severe injuries, the fracture may be open, with injuries to the ankle leaving the bone exposed. Medical imaging studies of the bone are taken to evaluate the fracture and develop a treatment plan.
In cases where the bone is roughly where it should be and the fracture is not severe, the treatment recommendation may be a cast, especially if a patient would be at increased risk of complications from foot surgery. Diabetic patients, for example, often do poorly after foot surgery, and there is a risk of creating more problems for the patient by operating. If the fracture is severe, surgery to pin the bone and then cast it to hold it in place during healing may be necessary.
Long term concerns with a calcaneal fracture include increased susceptibility to foot injuries in the future caused by ankle instability, gait changes potentially leading to knee and hip problems, or infections after surgery. Patients may have an extended healing time and usually require physical therapy to adjust after the fracture heals. During physical therapy, strength in the ankle will gradually be built up so the patient can walk safely.
It may be necessary to use a cane or walker for stability and people like athletes will usually need to curtail their activities during healing to avoid reinjuring the ankle. People with a history of this type of fracture should be especially careful about protecting their ankles while lifting weights, running, and engaging in other activities known to put stress on the ankle joint.
