How is a heel bone fracture treated?
Your provider will consider several factors in planning your treatment, including:
- The cause of your injury
- Your overall health
- The severity of your injury
- The extent of soft tissue damage
Because most calcaneus fractures cause the bone to widen and shorten, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better outcomes. In most cases, recreating the normal heel anatomy involves surgery. Your provider will discuss the different treatment options with you.
Nonsurgical treatment may be recommended if the pieces of broken bone have not been displaced by the force of the injury.
Immobilization. A cast, splint, or brace will hold the bones in your foot in proper position while they heal. You may have to wear a cast for 6 to 8 weeks — or possibly longer. During this time, you will not be able to put any weight on your foot until the bone is completely healed.
If the bones have shifted out of place (displaced), your provider may recommend surgery.
Surgery to repair a calcaneus fracture can restore the normal shape of the bone but is sometimes associated with complications, such as wound healing problems, infection, and nerve damage. Nonsurgical treatment of some fractures, however, can also lead to long-term complications, such as pain, arthritis, and a limp. Your provider will review the details of your injury and talk with you about the risks and benefits of surgical versus nonsurgical treatment.
Timing of surgery. If the skin around your fracture has not been broken, your provider may recommend waiting until swelling has gone down before having surgery. Elevating your leg and keeping it immobilized for several days will decrease swelling. It will also give stretched skin a chance to recover. Waiting before the operation may improve your overall recovery from surgery and decrease your risk of infection.
Open fractures, however, expose the fracture site to the environment and must be treated immediately. They require surgery to clean the wound and remove damaged tissue
Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon splits away from the bone (avulsion). For this type of fracture, emergent surgery can decrease the risk of injury to the skin around the Achilles tendon.
What surgical procedures are used to treat heel bone fractures?
The following procedures are used for various types of calcaneus fractures:
Percutaneous screw fixation. If the bone pieces are large, they can sometimes be moved back into place without making a large incision. Special screws are then inserted through small incisions to hold the fracture together.
Open reduction and internal fixation. During this operation, an open incision is made to reposition (reduce) the bones into their normal alignment. They are held together with wires or metal plates and screws.
Bones have a remarkable capacity to heal. The more severe your injury, however, the longer your recovery may be. Patients with more severe fractures are also more likely to suffer some degree of permanent loss of function, regardless of treatment.
What is recovery like after heel bone fracture treatment?
Whether your treatment is surgical or nonsurgical, your rehabilitation will be very similar. The time it takes to return to daily activities will vary depending on the type and severity of the fracture and whether you have other injuries.
Some patients can begin weight-bearing activities a few weeks after injury or surgery; others may need to wait 3 months or more before putting weight on the heel. Most patients are able to begin partial weight bearing between 6 and 10 weeks after injury or surgery.
Early motion. Many providers encourage motion of the foot and ankle early in the recovery period. For example, you may be instructed to begin moving the affected area as soon as your pain allows. If you have had surgery, you may be instructed to begin moving the affected area as soon as the wound heals to your provider’s satisfaction.
Physical therapy. Specific exercises can help improve the range of motion in your foot and ankle, and strengthen supporting muscles. Although they are often painful at the beginning and progress may be difficult, exercises are required in order for you to resume normal activities.
Weight bearing. When you begin walking, you may need to use crutches, a cane, or a walker and/or wear a special boot. It is very important to follow your provider's instructions for walking on your foot. If you put weight on your foot too soon, the bone pieces may move out of place and you might require surgery. If you have had surgery, the screws might loosen or break and the bone may collapse. This may not occur the first time you walk on it but, if the bone is not healed and you continue to bear weight, the metal will eventually break.
What complications can be caused by heel bone fractures?
Complications often occur with calcaneus fractures.
Minor complications include:
- Small or temporary areas of delayed wound healing
- Nerve irritation around the incision
- Tendon irritation
- Joint stiffness
- Chronic pain
- Chronic swelling
Major complications include:
- Failure of the wound to heal
- Posttraumatic arthritis (with or without surgery)
It is important to tell your provider if you are a smoker. Smoking affects both bone and wound healing. With or without surgery, your bone may take longer to heal if you smoke.
Additional surgery is usually required in cases of infection or wound healing complications. If all attempts to resolve an infection or a wound healing complication fail, an amputation may be necessary.
How long does it take for a broken heel bone to heal?
If your injury is minor, such as a crack in the bone with little muscle damage, you may be able to resume normal activities from 3 to 4 months after surgery. If your fracture is severe, however, it may take from 1 to 2 years before recovery is complete.
Despite the best efforts of the provider and patient, normal foot and ankle motion is rarely regained after a severe fracture and patients do not typically resume their pre-injury level of function. A patient who is not very active might tolerate a foot that is not normal. On the other hand, a patient whose job or recreational activities require a lot of walking or climbing will notice more.
What are some common problems that patients experience after breaking their heel bone?
Common problems that may persist after recovery include:
- Skin irritation. Footwear can irritate the skin or tendons in the affected area.
- Altered gait. In some cases, the arch of the foot has not been restored, or the Achilles tendon has not healed at its normal distance from the ankle. Full motion between the talus and the calcaneus is rarely regained in these cases, and this can change the way you walk. You may have problems walking on uneven ground, such as grassy surfaces or hills.
- Pain. Following a fracture, you may experience continued subtalar pain and limited motion. Even if the heel anatomy is perfectly restored, you may still have discomfort. This can happen because of injured soft tissues, persistent fracture displacement, or limited ankle and subtalar range of motion. Although relatively uncommon, pain can also be caused by irritation from the plates or screws.
What further treatment can be done if complications from heel bone fracture persist?
If you have chronic pain or experience other complications, you may need further treatment. This may include:
Orthotics. A simple shoe modification may help some chronic problems. You may need to wear a heel pad, lift, or shoe cup, as well as special shoes with extra depth in the toe compartment.
Additional surgery. Sometimes, another major operation is required. If the bone has healed in a deformed position, or if the subtalar joint becomes arthritic, the joint between the talus and the calcaneus may need to be fused. The goal of this procedure is to help the talus and the calcaneus grow together to form one bone.
Fusion means that no more motion can occur between the two bones. If the bone is badly deformed, your doctor may attempt to correct some or all of the deformity along with the fusion.