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Fractures of the Heel Bone

(Calcaneus Fractures)

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Fractures occur in the heel bone (calcaneus), located at the back of the foot.

  • Heel fractures usually result from great force and thus are often accompanied by knee and spine injuries.

  • If the heel bone is fractured, the heel is tender, and the foot and ankle are usually swollen and cannot bear weight.

  • Usually, doctors can diagnose heel fractures based on x-rays, but sometimes computed tomography is needed.

  • Doctors consult an orthopedist to determine the best treatment for heel fractures.

  • Treatment may consist of protection (usually by a splint), rest, ice, compression, and elevation (PRICE), followed by a cast, or surgery to put the broken pieces of bone back in place and keep them in place.

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.

Heel fractures usually result from great force, as when people land on their feet after falling from a height (such as falling off a ladder). Other causes include car crashes and sports-related injuries. Because heel fractures require great force, the knees and/or spine are often also injured.

Some heel fractures extend into the joint, fracturing the cartilage that enables the joint to move smoothly.

Stress fractures may also occur in the heel bone, particularly in long-distance runners and other athletes. Stress fractures are incomplete breaks in the bone caused by repeated stress rather than a single injury.

Locating the Heel Bone

The heel bone (calcaneus) is located at the back of the foot.

Symptoms

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 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.

Diagnosis

  • X-rays

  • Sometimes computed tomography

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 heel fractures result from great force, doctors also check for other injuries, such as fractures of the knee or spine.

Treatment

  • Consultation with an orthopedic specialist

  • Sometimes protection (usually by a splint), rest, ice, compression, and elevation

  • A cast (after the swelling goes down)

  • Possibly surgery

  • Physical therapy after it has healed

Doctors consult a specialist (orthopedist) to determine the best treatment for heel fractures. Depending on the type of fracture, surgery may be needed.

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). After the swelling goes down, the person may be referred to an orthopedist, who applies a cast.

When a heel fracture affects the joint, whether surgery is the best treatment is debated. If surgery is needed, open reduction with internal fixation (ORIF) is done.

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.

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