The calcaneus, also known as the heel bone, is the largest of seven tarsal bones in the foot. It is located at the back of the foot (hindfoot) below the ankle joint. The calcaneus and the talus (small bone in the foot that acts as a hinge between the tibia and fibula) form the subtalar joint. This joint allows for side-to-side movement of the hindfoot and plays an important role in establishing balance.
Trauma to the heel, by fall or an accident, may cause the heel bone to break or shatter. Calcaneal fractures can also be caused by a stress fracture. Men between the ages of 30 and 50 years old are most likely to experience this type of injury – which often occurs from a high-impact event such as a fall from a ladder or a motor vehicle accident.
A calcaneal fracture will result in swelling of the heel, bruising of the heel and ankle, and an inability to put weight on the heel. Pain generally affects only one area of your heel and may be tender or warm to the touch. Deformity of the heel may also be present in more severe cases.
With a stress fracture, symptoms may present as a dull ache that becomes increasingly irritating throughout the day and can make walking difficult. Stress fractures are commonly caused by long-term, repetitive stress on the heel bone, such as from jogging.
A physical exam and X-rays/CT scans are used to diagnose a calcaneal fracture and determine the extent of the injury. The severity will depend on the number of fractures, the size of bone fragments, the amount of displacement between fragments, and whether the injury affects surrounding cartilage surfaces.
Calcaneal stress fractures typically heal with conservative methods, over a period of six to eight weeks. Your doctor may prescribe a boot, splint, or cast to keep your foot stable and limit weight on the fracture site. Similarly, if the pieces or broke bone have not been displaced, your doctor may take a nonsurgical approach to treatment.
If the bones have been displaced, then your doctor may recommend surgery.
The road to recovery is similar for patients treated by surgical or nonsurgical methods. Most patients can being partial weight-bearing about 6 to 12 weeks after the initial injury or surgery.
If surgery is required, the foot will be immobilized in a splint, while iced and elevated during throughout the first two weeks. Your sutures will be removed during weeks 2-6 of the recovery period, and you will be placed in either a hard case or a removable boot. While you should remain non-weight-bearing at this stage, your doctor may encourage you to try gentle range-of-motion exercises.
At the 6 – 12 week mark, you may continue with gentle motions of the foot and ankle. Physical therapy may be introduced as you gradually increase weight-bearing force. Your surgeon will re-evaluate your healing progress at the end of week 12 and may transition you out of a cast/boot into an ankle brace.
Once you begin walking and weight-bearing more consistently, you may require the use of aids such as crutches, a cane, or a walker. If you place weight on your foot to soon following injury or surgery then the bone pieces or surgical screws may shift and cause more damage. It is important to carefully follow your doctor’s instructions when it comes to rehabilitation and recovery.
Once the bone has healed your doctor may recommend that you continue with physical therapy to improve balance and strength. Shoe modifications (orthotics), such as heel pads and lifts, can offer relief from heel or ankle irritation both during and after the recovery period.
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