Some, but not all, calcaneus fractures require surgery. The broken bone will take months to heal with or without surgery. If surgery is not needed, there will still be a time where movement and weight bearing is limited.
Calcaneus fractures that benefit from surgery often involve breaks within the subtalar joint the joint just below your ankle joint.
The subtalar joint lets your foot move from side to side, as compared to the ankle joint, which moves your ankle up and down. Surgery may be also be needed to address changes in the shape of your bone: typically flattening, widening, or the bone has shifted into a bad position. You should discuss your specific injury and the advantages of surgery vs.
Surgery is almost always required if the bone came through your skin or is close to breaking through the skin. If surgery is needed, an incision, or "cut," is generally made along the outside part of your foot over the heel bone. The bone fragments are put back into the right place, and metal plates and screws are used to fit and hold the bone pieces back together until your bone heals. While your broken calcaneus is healing, you will not be able to put weight on your foot.
You will likely be immobilized in a well-padded splint. Sometimes physical therapy is prescribed to help with motion and weight bearing once the bone heals. Your ability to move your foot and ankle and put more weight on your leg will improve as your bone heals. Typically, you will not be able to put any weight on your broken foot for 4 to 12 weeks. When you start putting weight on it, it may only be part of your weight. It can take 3 months or longer of healing before you are able to put your full weight on your injured foot.
This may occur whether you had surgery or not. For best results, it is important to follow instructions from your surgeon regarding your care. The heel can also remain swollen compared to the uninjured side. Some patients have lingering pain with walking, especially on uneven ground. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Fractures involving the joints intra-articular fractures are the most severe calcaneal fractures and include damage to the cartilage the connective tissue between two bones. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.
The signs and symptoms of traumatic fractures may include:. To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle and order x-rays. In addition, advanced imaging tests are commonly required. Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or nonsurgical—for the fracture.
Whether the treatment for a calcaneal fracture has been surgical or nonsurgical, physical therapy often plays a key role in regaining strength and restoring function. This apophysis solidifies, or fuses, around 15 years of age.
In some males, it doesn't finish ossifying hardening into solid bone until 22 years of age. The calcaneus is at the posterior back of the foot where the heel is located. This location allows the calcaneus to act as a fulcrum point for flexion and extension of the foot. Flexion is what happens when you lift your toes off the floor as you're about to tap your foot.
Extension is what happens when you're pushing on the gas pedal. There are several anatomical variations of the calcaneus that can be seen on medical images. Some of these may be related to certain medical conditions, while others may not result in any complaint and are noted only because they are often identified by radiologists. The calcaneus provides one point of a solid tripedal surface for the foot.
It also provides a fulcrum for extension and flexion of the foot. The Achilles tendon is the strongest tendon in the body. It is the common tendon for the gastrocnemius calf muscle. Think about how short the calcaneus is as a lever, but how much force it takes for that short lever to lift the entire body weight.
The body is able to do that using just one of the two Achilles tendons. Obviously, direct trauma to the calcaneus will be a cause of pain. However, there are several non-traumatic or repetitive stress injuries that can cause pain in high impact bones like the calcaneus. Heel pain is a common symptom associated with the calcaneus. Calcaneal apophysitis is the most common cause of heel pain in children. A bursa is a fluid-filled sac that acts as a bumper or cushion between potentially tender areas and tissue that can irritate them.
Bursitis that can cause heel or foot pain is an inflammation of the bursae that are commonly found around the insertion points of tendons or between articulated tarsal bones such as the talus and calcaneus talocalcaneal joint. Plantar fasciitis is the most common cause of heel and foot pain in adults. This common tendonitis occurs frequently in runners and can be hard to remedy. Repetitively striking the heel can lead to the development of stress fractures in the calcaneus. These are often minor cracks that cause pain in the foot.
Rarely is a stress fracture very large, but it takes time to heal because it is in the heel. When a tendon rips free of an insertion point, it is known as an avulsion fracture. Usually, the tendon doesn't come apart from the bone, but the bone to which it is attached might break loose, hence the term.
There are two major tendon insertion points on the calcaneus: the Achilles tendon and the plantar fascia tendon. Achilles tendon ruptures are common, but avulsion fractures are not.
Calcaneus injury treatment depends on the type and severity of the injury. In general, your healthcare provider may try to use conservative, nonsurgical treatment first.
If that doesn't work, surgery might be necessary to correct an injury. Rehabilitation depends on the severity of the injury and on the choice of treatment. Physical therapy using stretches, massage, and exercises is the most common treatment for plantar fasciitis.
Depending on the healthcare provider, you might be directed to use the RICE method rest, ice, compression, and elevation for treatment or you might be encouraged to use the METH technique movement, elevation, traction, and heat.
There's not a clear winner between these two methods. If the plantar fasciitis is severe, your healthcare provider may prescribe a brace and splint to help your plantar fascia heal. In some cases, you will only wear the brace at night while sleeping to assist in stretching the plantar fascia. If the bone is not displaced due to a fracture, meaning that all the pieces are in the right places, nonsurgical treatment might be appropriate. This is the most common type of treatment for patients with stress fractures of the calcaneus.
In the case of severe trauma and complete fractures with displacement, it is often necessary for surgical repair. Once the surgery is done, the patient will still be required to keep pressure off of the heel.
Usually, the patient will use braces or splints to hold the heel in the correct position and prevent movement. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
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