The calcaneus (also known as the heel bone), is a large bone that forms the foundation of the rear part of the foot. The calcaneus connects with the talus and cuboid bones. The connection between the talus and calcaneus forms the subtalar joint; this specific joint is therefore important for regular foot functions.
The calcaneus is often compared to a hard-boiled egg because it has a very thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell is broken, the bone tends to collapse and becomes fragmented. For this reason, injuries can become severe. Furthermore, if an injury involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.
A fracture is a break, typically in a bone. If the broken bone punctures the skin, it is then called an ‘open’ or ‘compound’ fracture. Fractures often occur due to car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can also cause stress fractures, which are very small cracks in the bone.
A calcaneus fracture is a tiny break in the heel bone due to repetitive activity on the foot. That repetitive activity can cause small amounts of trauma to the bone, and without enough healing time between activities, it may result in microscopic damage that can progress to a stress fracture.
This usually happens with overuse or a sudden increase in an activity like running. Additionally, the calcaneus is the second most common location for stress fractures in the foot.
Causes & Symptoms of a Calcaneus Fracture
A calcaneus fracture occurs when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle).
The joint between the calcaneus and the talus is known as the subtalar joint, and it is an essential biomechanical component of flexing, standing, and walking, and couples with the ankle joint for dynamic motion.
This joint is often involved in these types of fractures which may lead to long-term complications with the affected joint such as chronic pain, stiffness, and the development of arthritis.
Treating a heel fracture can be tricky because the fracture is rarely a clean break like you might see in a broken shin or arm.
Imagine the calcaneus as an egg; with an intact shell it is difficult to break when you squeeze it in the palm of your hand, however, if there’s any defect or crack in the surface, any abnormal pressure to the shell causes it to suddenly crumble as the center is soft and sponge-like.
When the calcaneus fractures, the hard outer layer can break into multiple irregular fragments and fold in on itself, just like an egg with a broken shell.
There are many other types of fracture patterns that can occur with trauma to the heel bone. Some have more simple patterns that do not involve the joint and typically heal without any long-term problems while others are much more complex with fragment displacement and extend into one of the multiple joints and are very challenging to get to recover properly, often requiring surgical intervention to help optimize healing. Therefore, here are some of the most common types of calcaneus fractures:
- Intra-articular fractures – These involve damage to the cartilage between the joints and are considered the most serious type of calcaneus fracture. These have a high correlation with the eventual development of post-traumatic arthritis of the affected joint.
- Avulsion fractures – A fragment of bone is avulsed away from the calcaneus from the pulling from the Achilles tendon or another ligament.
- Multiple fracture fragments – This is also called a crushed heel injury and is more common with higher impact injuries such as a fall from height or automotive accident.
- Stress fractures – While most calcaneal fractures are caused by a trauma, a calcaneal stress fracture can result from overuse or repetitive trauma (such as a high volume of running or jumping).
If you have fractured your heel bone, you will most likely find it difficult and painful to put any weight on the affected foot. You may notice heel pain, discomfort, and swelling even when resting the fractured heel.
The specific location on the heel where the fracture occurred will most likely be very tender to the touch. Pain from a stress fracture is usually worse during physical activities or exercise, especially high-impact exercises like running, basketball, or soccer. For many calcaneus fractures, the pain comes on very suddenly as a result of a fall or a sudden leap to a hard surface, where a small crack is created in the bone. However, in other cases, the fracture does not occur all at the same time.
For any fracture, it is recommended to look out for these symptoms listed below:
- Pain that worsens the longer you stay on your feet.
- Swelling or redness in the affected foot.
- Pain that improves somewhat with a long period of rest.
- Pain that is more intense in a single spot on the heel (although the pain may radiate out to other areas) and is painful to the touch.
Who gets a Calcaneus Fracture?
Calcaneus fractures are most commonly suffered after a fall, although automobile accidents can also cause such fractures to the heel bone. In addition, men between the age of 30 and 50 years fracture their calcaneal most often of any age group or sex.
How Does a Calcaneus Fracture Affect You? How Serious is it?
When a heel bone is severely fractured, surgical treatment is usually required in order to repair the affected joint (surgeries require incisions – cuts that allow surgeons to open an area of the body and make repairs).
Therefore, this means there is a slight chance of infection but with a low percentage of it happening. When infections do arise, however, they are considered serious. Therefore, common surgical complications may include:
Infection
In mild cases, infections can be treated with oral antibiotics. In more severe cases, the entire surgical may become compromised and require the removal of hardware and any infected tissue or bone. Osteomyelitis is a severe deep-wound infection that affects the bone, and the calcaneus is particularly vulnerable following this type of injury.
Nerve damage
You may experience permanent numbness at the surgical site. In some cases, the sural nerve (which runs through in incision site) may become entrapped in scar tissue and can become quite painful.
Subtalar arthritis
This is a chronic pain condition that commonly affects patients with healed calcaneal fractures. If this occurs, at some point you may need to undergo an additional procedure to fuse the affected joints, especially the subtalar joint.
Healing problems
Because circulation to the heel’s soft tissues is overall weak, the surgical site may not heal properly and may require additional wound care.
Recommended Calcaneus Fracture Treatment & Rehabilitation
If you have recently experienced a calcaneus fracture and are experiencing symptoms of the condition, it is recommended to visit a foot specialist, known as a podiatrist. Your doctor will begin by evaluating your foot for swelling and other signs of a fracture or joint damage.
X-ray imaging can be helpful in making a diagnosis. Your doctor may also order a CT scan to get a better idea of the pattern of the fracture, to determine whether surgery is needed. Depending on the cause of your injury, your podiatrist may also want to examine you for an ankle or mid-foot injury or refer you to another specialist to check for injuries beyond the affected foot.
If surgery is required, you may be required to undergo either an open surgical approach or a percutaneous approach, as described below:
Open surgical approach
Your surgeon will reconstruct the heel bone to something close to its original shape. Because each fracture is different, each surgical procedure is individualized. Usually, surgery cannot begin until the swelling has reduced, about 10-13 days prior to the trauma. Operating on a swollen foot may lead to healing problems and it can increase the risk for infection.
Percutaneous Approach
This is a small invasive surgical technique that can be performed on some less complex fractures. Your surgeon makes a small incision and pierces the pieces of a fractured bone with a surgical wire. Afterwards, your surgeon will then manipulate the pieces into place.
Once the surgical procedure has finished, you’ll be required to wear a bandage for one to two weeks after surgery, and possibly a cast, walking boot, or an ankle splint for up to three weeks after open surgery.
You may also receive a pair of crutches or a cane to help support further walking. The surgical area will be swollen and painful, so you will need to avoid walking for at least a few days. Adding too much weight to your calcaneus bone after surgery can delay healing. It is highly recommended to follow up with your surgeon within a couple of weeks after surgery. Soon after, you should be able to put some weight on your heel once the swelling and pain have lessened due to the fracture.
A person with employment that requires being seated for a long period of time might only need just a few weeks off after this type of surgery. If a patient’s employment involves standing or walking throughout the entirety of his or her workday, four weeks off of work is needed to recover sooner.
Some exercise methods to try at home can also be performed in order to ease the pain from your calcaneus fracture or other conditions linked to heel pain. Here are four recommended methods:
Calf stretch
Stand at an arm’s length from the wall, then put your right foot behind the left. With your hands being braced onto the wall, slowly bend your left leg forward, keeping your right knee straight and your right heel on the ground. Hold this position for 15-30 seconds, then release afterward. Repeat the procedure three times then switch legs.
Foot roll
Find a comfortable chair that can allow you to sit upright. Then roll your foot gently back and forth on a round object like a frozen water bottle, or a foam roller. Repeat this step for a minute before switching to the other foot.
Big toe stretch
In a comfortable seated position, cross one leg over the other. Grab onto your big toe and then gently pull it towards yourself, holding this position for 15-30 seconds. Repeat this method three times before switching to the other toes.
Towel stretch
Fold a towel lengthwise to make a strap. Then while seated, place the folded towel under the arch of the foot. Grab the ends of the towel with both hands and gently pull your foot towards you. Hold this stretch for 15-30 seconds and then switch to the other foot.
Alternative & Homeopathic Treatment
Most alternative treatments can help relieve some symptoms regarding your calcaneus fracture without seeing a doctor. These are a great combination of heel pain remedies that you can feel free to try at home, including:
- Rest – Take the weight off your heel as much as possible, for at least a week. Crutches may help when you must move around elsewhere.
- Ice – Apply ice to your affected heel at least twice daily, for 10-15 minutes at a time.
- Supportive shoes – If it is needed, switch to more supportive, comfortable shoes. If your pain is behind your heel, try different shoes that do not have backs to avoid further pressure on this area.
- Foot padding – You can buy over-the-counter shoe inserts, foot cups, or heel pads to help relieve pain and pressure on your heel.