Fractures of the Heel Bone
Fractures occur in the heel bone (calcaneus), located at the back of the foot (see Figure: Foot Fractures).
Only about 1 to 2% of all fractures are heel bone fractures. However, such fractures can lead to long-lasting problems (such as arthritis), especially if the fractures are not diagnosed and treated promptly.
These fractures usually result from great force, as when people land on their feet after falling from a height (such as a ladder). Most of these heel fractures extend into the joint, fracturing the cartilage that enables the joint to move smoothly. Sometimes the knees and/or spine are also injured in such a fall. Other causes include car crashes and sports-related injuries.
Stress fractures may also occur in the heel bone, particularly in long-distance runners and other athletes (see Stress Fractures of the Foot). Stress fractures are incomplete breaks in the bone caused by repeated stress rather than a single injury.
The heel is tender. The foot and ankle are usually very swollen and may be bruised. People are unable to put weight on their foot.
Compartment syndrome (see Compartment Syndrome) may develop. It develops when swelling puts pressure on nearby blood vessels, reducing or blocking blood flow. As a result, tissues that are deprived of blood may be damaged or die. Immediate treatment is crucial.
If doctors suspect that the heel bone is fractured, they take x-rays, which usually show the fracture if present. But sometimes computed tomography (CT) is needed. CT combines x-rays with computer technology to produce a more detailed, three-dimensional image of the injured area.
Because these fractures result from great force, doctors also check for other injuries, such as fractures of the knee or spine.
Doctors consult a specialist (orthopedist) to determine the best treatment.
If the fracture does not affect the joint, treatment involves protection (usually by a splint), rest (staying off the foot and using crutches), ice, compression (pressure), and elevation (PRICE—see PRICE). After the swelling goes down, the person may be referred to an orthopedist, who applies a cast.
When the fracture affects the joint, whether surgery is the best treatment is debated. If surgery is needed, open reduction with internal fixation (ORIF) is done (see Surgery).
People are instructed not to put any weight on the heel until the fracture heals. How long they have to wait depends on the injury and may be as long as several months. Often, doctors encourage people to move the foot and ankle and sometimes to put weight on the ankle as soon as doing so is not too painful.
Physical therapy is required. It consists of specific exercises to improve the range of motion of the affected foot and ankle and to strengthen supporting muscles.
When people start to walk, they may need a cane or a specially designed shoe or boot that protects the foot from further injury. If people do not precisely follow the doctor's instructions about when to start walking and how to walk, the bone may not heal well.