Heel Bone Fractures

Causes

Most calcaneal fractures are the result of a traumatic event — most commonly, falling from a height, such as a ladder, or being in a car accident where the heel is crushed against the floorboard. 

Types of Calcaneal Fractures 

Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints are the most severe calcaneal fractures and include damage to the cartilage.

Fractures that don’t involve the joint include:

• Those caused by trauma, such as avulsion fractures or crush injuries resulting in multiple fracture fragments.
• Stress fractures, caused by overuse or mild injury.

Symptoms

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:

• Sudden pain in the heel and inability to bear weight on that foot.
• Swelling in the heel area.
• Bruising of the heel and ankle.

The signs and symptoms of stress fractures may include:

• Generalized pain in the heel area 
• Swelling in the heel area

Diagnosis

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.

Non-surgical Treatment

For some fractures, non-surgical treatments may be used. These include:

• Rest, ice, compression, and elevation
• Immobilization. 

For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. 

Rehabilitation 

Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.

Complications of Calcaneal Fractures 

Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences of calcaneal fractures are decreased ankle motion and walking with a limp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery or long term or permanent use of a brace or an orthotic device to help manage these complications.

When is Surgery Needed?

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.