FOOT & ANKLE

Calcaneus Fractures

The calcaneus or heel bone is the largest bone in the ankle forming the heel and is situated at the lower back part of the foot. The calcaneus connects with the talus and cuboid bones to form the subtalar joint of the foot and helps the inward and outward movement of the foot. Fracture of the calcaneus reduces or prevents movement of the subtalar joint. Calcaneus fractures may lead to deformity of the calcaneus bone, irregularity of the subtalar joint, arthritis, and affect the surrounding tendons and nerves of the heel.

Calcaneus fractures are divided into intra-articular or extra-articular fractures based on the involvement of the subtalar joint. Intra-articular fractures involve the joint and any of the three subtalar articulating facets (location where two bones meet). Extra-articular fractures may involve the calcanus body and associated structures, but not the joint.



Symptoms

The common symptoms for calcaneal fractures include:

  • Pain
  • Bruised heel and ankle
  • Swelling
  • Heel deformity
  • Difficulty walking and weight bearing on the injured heel
  • Inability or limited inward and outward movement of the foot


Causes

Calcaneus fractures are mostly caused due to trauma or high impact conditions such as fall from a height or motor vehicle accidents. Ankle sprain or stress fracture may also cause the heel bone to become fractured.



Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history and physically inspecting the injured area. An X-ray may be taken to identify whether the calcaneus is broken or bones are displaced. A CT scan may be ordered after an X-ray to provide further information about the severity of the injury.



Treatment Options

Calcaneus fractures are treated based on the type of fracture and extent of soft tissue damage.


Non Operative Treatment

  • Rest Ice Compression Elevation (R.I.C.E.) therapy: Allow the foot to rest to promote healing. Ice the injured area to reduce swelling, pain and inflammation. Use compression stocking or a bandage. Position the feet above heart level to reduce swelling.
  • Immobilisation: If the fracture has not displaced, your foot will be partially or completely immobilised. Casting the injury prevents movement of the fractured bone. Crutches are also advised to help with walking to avoid bearing body weight.


Surgery

Surgery is recommended for intra-articular or displaced calcaneus fractures, this procedure is called an open reduction and internal fixation. During this operation an open incision is made to reposition (reduce) the bones into their normal alignment.  The fractured bones are fixed in place with wires or metal plates and screws. This procedure minimises the chance of developing arthritis and allows inward and outward movement of the foot. Your foot will be plastered again to prevent movement of the ankle.

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