Calcaneal Fractures: Causes, Symptoms, and Treatment

What is a Calcaneal Fracture?

A calcaneal fracture occurs in the heel bone, the largest bone in the foot. These fractures can range from mild (stress fractures) to severe (comminuted fractures involving multiple fragments). Calcaneal fractures often result from high-energy trauma and can cause long-term complications if not managed properly.

Causes of Calcaneal Fractures

Traumatic Causes

• Falls from Height: Landing on the feet after falling from a significant height is the most common cause.

• Motor Vehicle Accidents: The impact of a crash can lead to calcaneal fractures.

• Sports Injuries: High-impact sports or activities can contribute to fractures.

Stress Fractures

• Repetitive overuse or stress, common in athletes and military personnel.

Types of Calcaneal Fractures

1. Intra-Articular Fractures

   • Involves the subtalar joint, which connects the calcaneus to the talus.

   • Accounts for approximately 75% of calcaneal fractures.

   • These fractures are more complex and can lead to arthritis if not treated effectively.

2. Extra-Articular Fractures

   • Does not involve the subtalar joint.

   • Includes fractures of the calcaneal tuberosity, sustentaculum tali, or body.

3. Open vs. Closed Fractures

   • Open Fractures: The bone pierces the skin, increasing the risk of infection.

   • Closed Fractures: The skin remains intact.

4. Comminuted Fractures

   • The calcaneus breaks into multiple pieces, often due to high-energy trauma.

Symptoms of Calcaneal Fractures

• Severe Heel Pain: Particularly upon weight-bearing or palpation.

• Swelling and Bruising: Around the heel and ankle.

• Deformity: Flattened or widened appearance of the heel.

• Inability to Bear Weight: Due to intense pain and instability.

• Stiffness: Limited movement in the ankle or subtalar joint.

Diagnosis of Calcaneal Fractures

Clinical Examination

• History and Physical Exam: Assessing pain, swelling, and deformity.

• Palpation: To identify areas of tenderness and rule out associated injuries.

Imaging Studies

• X-rays: To evaluate the fracture pattern and joint involvement.

• CT Scans: For detailed 3D imaging of complex or intra-articular fractures.

• MRI: Occasionally used to assess soft tissue injuries.

Treatment for Calcaneal Fractures

Non-Surgical Treatment

1. Immobilization

   • Use of a cast, splint, or boot to immobilize the foot and promote healing.

   • Typically recommended for non-displaced fractures.

2. Rest and Elevation

   • Avoid weight-bearing activities to reduce pain and swelling.

3. Pain Management

   • Anti-inflammatory medications or analgesics.

4. Physiotherapy

   • Once the fracture has healed sufficiently, exercises to improve strength, mobility, and balance are crucial.

Surgical Treatment

Surgery is often required for displaced or complex fractures.

1. Open Reduction and Internal Fixation (ORIF)

   • The bone fragments are realigned and secured with plates and screws.

2. Minimally Invasive Surgery

   • Small incisions are used to reposition and stabilize the bone.

3. Subtalar Fusion

   • Performed if the subtalar joint is severely damaged or arthritic.

Rehabilitation for Calcaneal Fractures

Early Phase

• Non-Weight-Bearing: Crutches or a wheelchair may be used for mobility.

• Swelling Control: Using ice, compression, and elevation.

Mid-Phase

• Progressive Weight-Bearing: Gradual transition to weight-bearing activities under supervision.

• Range of Motion Exercises: To prevent stiffness in the ankle and subtalar joint.

Late Phase

• Strengthening Exercises: Focused on the calf, foot, and ankle muscles.

• Functional Training: To restore balance, gait, and overall mobility.

Long-Term Outcomes

Recovery from calcaneal fractures can be lengthy and depends on the severity of the injury. Early and appropriate treatment, coupled with guided rehabilitation, is key to minimizing complications such as:

• Chronic pain.

• Arthritis in the subtalar joint.

• Gait abnormalities or reduced mobility.

Preventing Calcaneal Fractures

• Wear appropriate footwear for activities.

• Use protective gear during high-risk sports or occupations.

• Maintain strong and flexible muscles through regular exercise.

• Avoid overuse or repetitive stress on the feet.

Calcaneal fractures require expert management to ensure optimal recovery. At Palms Physiotherapy & Allied Health, our team provides personalized care and rehabilitation to help you regain strength, mobility, and confidence. Contact us today for professional support in your recovery journey.