Heel Bone Fractures (Calcaneus Fractures): Treatment Options

Heel Bone Fractures (Calcaneus Fractures): Treatment Options

This video will provide an overview of the treatment options for breaks in the heel bone, also known as calcaneus fractures. Treatment options, both with and without surgery, will be reviewed. In a brief review of the anatomy, the heel bone is the largest bone in the foot and resides in the hindfoot. Breaks to this bone may occur in various patterns, often determining the type of treatment needed.

Calcaneus fractures can be serious injuries and challenging to manage, and often require treatment initially in a hospital setting. It is key to work closely with a surgeon and health care team with the proper expertise and experience in their treatment for optimal outcomes. Treatment without surgery was historically the mainstay for treatment of these fractures. Over time, this has shifted, and only some fractures meet indications for nonoperative treatment.

These include fractures that are closed, meaning they have not come through the skin, and have no or minimal displacement and show no extension to the nearby joints. Patients at high risk for complications may also be treated without surgery. These include those who smoke, have poorly controlled diabetes, have decreased sensation, and poor blood supply to the feet. Treatment without surgery will consist of rest, ice, compression, and elevation, also known as the R.I.C.E. mnemonic.

In addition to R.I.C.E., patients may require over-the-counter or prescribed medication for pain. Eventually, physical therapy will be ordered to regain normal motion and strength and return to normal walking and activities. Determining the appropriate fracture types that require surgery is still controversial in the profession despite many large-scale studies. However, the common consensus is that fractures that are displaced and extend into the joint spaces will need surgery, especially as less invasive techniques have been developed.

Better strategies now exist to minimize healing complications after surgery. If surgery is advised, the surgical team will require that the blisters and swelling in the foot improve first, which may take 7-14 days after the injury. There are exceptions to this, including if the fracture has come through the skin, or the skin is at risk because of an impending open fracture. Many strategies to fix these fractures depend on the pattern of fracture seen.

Most commonly, screws or plates with screws will be needed to repair and align the bony fragments. Surgical incision placement will depend on the type of fracture and surgery required. Incisions are typically on the lateral or outside of the foot. In tongue-type fractures, in which there is a large fragment of broken bone in the back of the heel, additional small incisions will be made on the back of the heel to pass screws.

After surgery, patients will be closely monitored for healing at the fracture sites, around the incision, and soft tissues. Blood supply and sensation will also be closely monitored. Pain management will be provided. Rehabilitation will be critical and will be a gradual and monitored process, given the severity of these injuries. While a patient will be restricted to no or partial weight-bearing until adequate healing is seen on x-rays, early movement is typically encouraged to prevent stiffness.

Close follow-up with both the surgical and rehabilitation teams will be warranted to achieve optimal success in recovery.