What Is Calcaneus?

The heel bone, also known as the calcaneus, is a big bone that supports the back of the foot and is the site of calcaneal fractures. The cuboid and talus bones are connected to the calcaneus. The subtalar joint is made up of the talus and calcaneus.

Because it has a softer, spongy bone inside and a thin, hard shell outside, the calcaneus is frequently compared to a hardboiled egg. The bone tends to collapse and shatter when the outer shell breaks. Calcaneal fractures are therefore considered serious injuries. Moreover, long-term effects like arthritis and persistent discomfort could result from a fracture that affects the joints.

How Do Calcaneal Fractures Occur?

The majority of calcaneal fractures are caused by traumatic events, most frequently being in a car accident when the heel is crushed against the floorboard or falling from a height, such as a ladder. Ankle sprains and other injuries can potentially result in calcaneal fractures. Stress fractures, which result from overuse or repetitive stress on the heel bone, account for a lesser percentage of calcaneal fractures.

Types of Calcaneal Fractures

The subtalar and nearby joints may or may not be affected by calcaneus fractures. The most serious calcaneal fractures are those that involve the joints, or intra-articular fractures, and entail injury to the cartilage, which is the tissue that connects two bones. The degree to which the calcaneus was crushed at the moment of injury determines the prognosis for healing.

Fractures that do not involve the joint (extra-articular fractures) include:

  • Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the
  • calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments.
  • Stress fractures are caused by overuse or mild injury.

The severity and treatment of extra-articular fractures depend on their location and size.

Signs and Symptoms of Calcaneal Fractures

Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures. The signs and symptoms of traumatic fractures may include:

  • Sudden pain in the heel and inability to bear weight on that foot.
  • Swelling in the heel area
  • Bruising of the heel and ankle
  • The signs and symptoms of stress fractures may include:
  • Generalized pain in the heel area that usually develops slowly (over several days to weeks)
  • Swelling in the heel area

Diagnosis of Calcaneal Fractures

To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle and order x-rays. In addition, advanced imaging tests are commonly required.

Treatment of Calcaneal Fractures

Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment whether surgical or nonsurgical—for the fracture.

For some fractures, nonsurgical treatments may be used. These include:

  • Rest, ice, compression, and elevation (RICE). Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.
  • Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weight-bearing. For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical approach for the patient.

Rehabilitation of Calcaneal Fractures

Whether the treatment for a calcaneal fracture has been surgical or nonsurgical, physical therapy often plays a key role in regaining strength and restoring function.

Complications of Calcaneal Fractures

Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences of calcaneal fractures are decreased ankle motion, walking with a limp due to the collapse of the heel bone, and loss of length in the leg. Patients often require additional surgery and/or long-term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.

Why choose a foot and ankle surgeon?

Today's foremost authorities in foot and ankle care are foot and ankle surgeons. In addition to being referred to as podiatrists, DPMs, or even "foot and ankle doctors," doctors of podiatric medicine are board-certified surgical specialists within the podiatric field. Compared to other healthcare providers, foot and ankle surgeons possess the most education and training specifically focused on the foot and ankle. Foot and ankle surgeons treat all conditions affecting the foot and ankle, from the simple to the complex, in patients of all ages, including calcaneal fractures. Their intensive education and training qualify foot and ankle surgeons to perform a wide range of surgeries, including any surgery that may be indicated for calcaneal fractures.