What is a fracture of the calcaneus?

Fractures of the heel bone or calcaneus can be very debilitating injuries. When the heel bone is injured, it is typically caused by tremendous forces which impact on the foot, for example associated with falls from a height, or in a motor vehicle accident. If the bones have shifted out of place (a displaced fracture), you will most likely need surgery.

A variety of techniques and approaches have been used to treat these fractures and the choice of treatment depends on the malalignment of the broken pieces primarily, as well as risk factors such as smoking or diabetes. Screws and possible a metal plate may be used to hold the bones in place. A bone graft may be used to aid in the healing of the fractures. It may take up to a year for the injury to heal completely.

Depending on the type of job you have, you may not be able to return to the same type of work. Because of the amount of force needed to break the heel bone initially, even if your fracture heals properly, your foot may never be the same as it was before the injury. You may continue to experience stiffness and you may need to wear a heel pad, lift, or cup as well as special shoes with extra depth in the toe compartment.

Treatment of the Calcaneus Fracture

The ideal goal of treatment is to restore the alignment of the fractured bones and the overall dimensions of the heel as accurately as possible. This is performed to decrease the inevitable likelihood painful arthritis developing subsequently.

General Facts about the Surgery

• Surgery is oftentimes delayed until the swelling in the ankle has decreased. This delay is typically for more than a week.
• Sometimes the surgery may be performed more quickly if you are admitted to the hospital and placed on an intermittent compression foot pump.
• Surgery is performed under a general anesthetic, and takes approximately two hours to perform. The surgical procedure is called an open reduction and internal fixation, and may include an arthroscopic procedure.
• The surgery is performed through an incision on the outside of the heel which
  exposes the side of the heel and the fracture. Alternatively, small punctures are made instead of a large incision.
• A large bulky splint is placed after surgery to prevent movement of the ankle, decrease swelling, and decrease pain.

General Factors in Postoperative Recovery

In order to stay off your foot, you will need to use crutches, a walker, a wheelchair or a scooter type device called a roll about.

Your first follow up visit will be at approximately 2 weeks to check the incision healing.

Your stitches typically are removed once the skin has healed, approximately between 2 and 4 weeks.

Exercises of the foot and ankle are to be encouraged at about 2 weeks after surgery, with exaggerated motions of the ankle, by writing out the alphabet.

Weight-bearing is restricted for 10 12 weeks, but moving around with crutches or a walker device is encouraged to help prevent blood clots.

If you have access to a swimming pool, swim as soon as the incisions are completely dry and healed, which typically occurs by about 3 weeks, while maintaining non weight-bearing.

You should remove the boot for twenty minutes three times a day to do range of motion exercises.

Walking is started in the boot with gradual progression.

There will be swelling of the ankle and foot for approximately one year.

Stiffness of the subtalar joint is common after this surgery.

You will continue to improve your strength and movement for about one year.

You can expect to have some soreness, aching, and stiffness for about 6 months.

Exercise, work and activity after your calcaneus fracture

For many individuals, a return to an active lifestyle is difficult following this injury.

Some individuals are not able to return to a job which requires walking or climbing.

Post Operative Course

Day 1

• Foot is wrapped in a bulky splint
• Ice, elevate, and take pain medication
• Expect numbness in the foot for 12 24 hours
• Bloody drainage through the bandage is expected.
• Do not bear any weight

2 weeks

• First follow up in the office
• X-rays taken
• Dressing changed
• Sutures may be removed
• A removable boot is applied
• Start motion out of the boot as instructed
• Can shower, provided the incision is clean and dry
• Do not soak the foot until the incision is completely dry

6 weeks

• Start stationary bike. No resistance
• X-rays in the office

10 – 12 weeks

• Full weight bearing
• Continue physical therapy
• X-rays taken in the office