Fractures of the Calcaneus (Heel Bone Fracture)
Calcaneus, also known as the heel bone, is a large bone that forms the foundation of the rearfoot. This bone is involved in the movement of the subtalar joint, which allows the rearfoot to be mobile, and adapt to uneven terrains when walking.
The structure of the calcaneus is often compared to a hardboiled egg; the calcaneus has a hard outer shell that can bear the weight of the body. The interior of the calcaneus is composed of porous bone that is lighter in weight, and more fragile. In a calcaneal fracture, the entire bone collapses, and can longer bear the bodyweight. The fracture can also extend to neighboring joints and cause arthritis and chronic pain.
Cause:
Most calcaneal fractures result from traumatic events, such as falling from height, or an automobile accident. The direct impact on the calcaneal bone causes acute fractures. Less commonly, calcaneal fracture can occur from severe ankle sprains. Overuse or repetitive stress on the heel can also cause stress fracture of the calcaneus.
Calcaneal fractures can be broadly categorized into 2 types; intra-articular (involving the joints) or extra-articular (do not involve the joints) fractures. Intra-articular fractures are more common and can incurs damage to the joint cartilage. Extra-articular fractures are often avulsion fractures (a piece of bone pulled off the main piece of bone by a tendon), or stress fracture from overuse injury.
Symptoms:
Acute calcaneal fractures have sudden onset of pain in the heel, and patient will be unable to bear weight on it. Swelling, bruising at the heel and ankle might also be observed.
For stress fractures in the calcaneus, the pain develops slowly, and is often described as a dull pain. Swelling in the heel area might be observed.
Diagnosis:
A thorough history and physical examination must be performed. Evaluation of the foot, with special attention directed to the rearfoot is required. X-ray or computed tomography (CT) scan may be ordered to further assess the fracture pattern.
Treatment:
Treatment of the calcaneal fracture is dictated by the fracture pattern, joint involvement, skin involvement, and activity level of the patient. Conservative treatments can involve the following.
For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the subtalar joint. The foot and ankle specialist will choose the best surgical approach for the patient based on the severity of the fractures.
Calcaneus, also known as the heel bone, is a large bone that forms the foundation of the rearfoot. This bone is involved in the movement of the subtalar joint, which allows the rearfoot to be mobile, and adapt to uneven terrains when walking.
The structure of the calcaneus is often compared to a hardboiled egg; the calcaneus has a hard outer shell that can bear the weight of the body. The interior of the calcaneus is composed of porous bone that is lighter in weight, and more fragile. In a calcaneal fracture, the entire bone collapses, and can longer bear the bodyweight. The fracture can also extend to neighboring joints and cause arthritis and chronic pain.
Cause:
Most calcaneal fractures result from traumatic events, such as falling from height, or an automobile accident. The direct impact on the calcaneal bone causes acute fractures. Less commonly, calcaneal fracture can occur from severe ankle sprains. Overuse or repetitive stress on the heel can also cause stress fracture of the calcaneus.
Calcaneal fractures can be broadly categorized into 2 types; intra-articular (involving the joints) or extra-articular (do not involve the joints) fractures. Intra-articular fractures are more common and can incurs damage to the joint cartilage. Extra-articular fractures are often avulsion fractures (a piece of bone pulled off the main piece of bone by a tendon), or stress fracture from overuse injury.
Symptoms:
Acute calcaneal fractures have sudden onset of pain in the heel, and patient will be unable to bear weight on it. Swelling, bruising at the heel and ankle might also be observed.
For stress fractures in the calcaneus, the pain develops slowly, and is often described as a dull pain. Swelling in the heel area might be observed.
Diagnosis:
A thorough history and physical examination must be performed. Evaluation of the foot, with special attention directed to the rearfoot is required. X-ray or computed tomography (CT) scan may be ordered to further assess the fracture pattern.
Treatment:
Treatment of the calcaneal fracture is dictated by the fracture pattern, joint involvement, skin involvement, and activity level of the patient. Conservative treatments can involve the following.
- Rest, ice, compression, and elevation (RICE). Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) to reduce the swelling.
- Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weight bearing.
For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the subtalar joint. The foot and ankle specialist will choose the best surgical approach for the patient based on the severity of the fractures.