Fractures of the Calcaneus

With springtime upon us, warmer weather is coming, and spring-cleaning is right around the corner.  As people dust off the ladders and start climbing to fix the shutters and clean out the gutters, emergency rooms start seeing fractures of the calcaneus in waves. 

Fractures of the calcaneus, or heel bone, are the most commonly seen foot fractures, comprising about 75% of all foot fractures.  This makes up between 1-2% of all fractures of the body.  The most common mechanism of injury in a calcaneal fracture is a fall or jump from a height, as well as motor vehicle accidents. 

Fractures of the calcaneus can be devastating.  Because the skin and soft tissue surrounding the bone is so thin, the fractures can often present as open, and are prone to infection.  The crushing nature of the fracture has been likened to an egg exploding. 

The subtalar joint, which sits between the talus and the calcaneus, is commonly affected by most calcaneal fracture patterns. When the fracture line goes through the joint surface on the calcaneus, post-traumatic arthritis can develop.  The subtalar joint plays a key role in connecting the foot to the ankle, and injuries to this joint can have a huge impact on daily activities.  Thus, one of the critical things for the foot and ankle surgeon to evaluate is the integrity of this joint following injury. 

When a person presents to the emergency department with a suspected calcaneal fracture, the first thing that is done after the patient is evaluated and stabilized is to take x-rays of the foot.  Often the x-rays will not show the physician the entire picture, so a CT scan is usually necessary.  The CT scan can give much better images of the bones and joints involved. 

The decision to operate on a fractured calcaneus depends on a number of variables, both intrinsic to the injury pattern as well as factors determined by the patient’s overall health.  Patients that have diabetes, poor vascular flow to the legs, increased age, or other injuries that are more urgent than the foot may not be god candidates for surgery.  These patients, in certain circumstances, may be better off with limited intervention or conservative therapy, which may or may not be followed by further intervention in the future.

Looking at the injury pattern can also determine if surgical intervention is necessary.  Fractures that are displaced, meaning that the fragments are separated from each other and don’t line up anatomically, may need surgery to bring the pieces back together.  However, when the calcaneus is broken into too many pieces, or highly comminuted, surgery may not increase the likelihood of a positive outcome.  The condition of the skin can also influence the decision.  If the skin is very swollen, or if there is a lot of blood in the skin, surgery may be postponed until the swelling has a chance to subside.

Surgery for calcaneal fractures has been an area of great interest in orthopedic and podiatric surgery for a very long time, and continues to be an area that is discussed at length.  A number of different surgical techniques exist, and every case is different.  The research has led to greater outcomes following surgery, but a calcaneal fracture can still turn into a truly life-altering event.  

Central Florida Foot and Ankle Center, LLC. 
101 6TH St. NW. 
Winter Haven, Fl. 33881 
863-299-4551 
www.FLFootandAnkle.com