Heel bone fractures

Background

Fractures of the heel bone (calcaneum) are high-energy, complex fractures that result from a fall from height or head on car impacts. The heel bone sits beneath the ankle bone and absorbs the impact forces of injuries. The heel bone shortens, widens and the joint between the ankle bone and heel bone is damaged and rotated.

There are often other injuries present such as spinal fractures. These injuries are initially treated by rest, elevation and ice, to reduce the swelling.

 

Treatment options

Xrays and CT scans are performed to determine if the fractures can be treated in a cast/boot or surgery.

Such surgery should only be performed by a fully trained and experienced orthopaedic surgeon.

These bones take 3 months to heal before weight bearing can be started.

 

Benefits of surgery

Surgery is aimed at reversing the displacement of the heel bone; namely to restore the height and width of the bone and subtalar joint congruity.

The heel bone is vital to bearing weight of the body and needs to fit into shoes. Surgery improves the chance of a functional recovery.

There is a risk of secondary joint arthritis after major joint damage. Joint realignment reduces this risk although studies have not yet shown this to be the case in heel bone fractures.

 

Risks of surgery

The main risk is of poor wound healing and infection. It is vital not to operate too soon when significant swelling is present. Smoking is the most important risk factor. If smoking cannot be stopped, surgery is not advised.

 

Outcomes

Patients with heel bone fractures rarely return to 'normal'. Return to work and light exercise is probable for most. Heavy manual work and road running are unlikely.

Recovery takes place gradually over at least 1 year.

 

A heel bone fracture with severe joint damage                                     The same bone after fixation with a plate and screws

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