What is the Calcaneus?
The calcaneus, also called 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 joint is important for normal foot function.
The calcaneus is often compared to a hard boiled egg, because it has a 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 become fragmented. For this reason, calcaneal fractures are severe injuries. Furthermore, if the fracture involves the joints, there is the potential for long-term consequences such as arthritis and chronic pain.
How do Calcaneal Fractures Occur?
Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.
Types of Calcaneal Fractures
Fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury.
Fractures that don’t involve the joint (extra-articular fractures) include:
- Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments
- Stress fractures, caused by overuse or mild injury.
The severity and treatment of extra-articular fractures depend on their location and size.
Signs and Symptoms
Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures.
The signs and symptoms of traumatic fractures may include:
- Sudden pain in the heel and inability to bear weight on that foot
- Swelling in the heel area
- Bruising of the heel and ankle
The signs and symptoms of stress fractures may include:
- Generalized pain in the heel area that usually develops slowly (over several days to weeks)
- Swelling in the heel area
To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle, and order x-rays. In addition, advanced imaging tests are commonly required.
Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or non-surgical—for the fracture.
For some fractures, non-surgical treatments may be used. These include:
- Rest, ice, compression, and elevation (R.I.C.E.) Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.
- Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weightbearing.
For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. The surgeon will choose the best surgical approach for the patient.
Whether the treatment for a calcaneal fracture has been surgical or non-surgical, physical therapy often plays a key role in regaining strength and restoring function.
Complications of Calcaneal Fractures
Calcaneal fractures can be serious injuries that may produce lifelong problems. Arthritis, stiffness, and pain in the joint frequently develop. Sometimes the fractured bone fails to heal in the proper position. Other possible long-term consequences ofcalcaneal fractures are decreased ankle motion and walking with alimp due to collapse of the heel bone and loss of length in the leg. Patients often require additional surgery and/or long term or permanent use of a brace or an orthotic device (arch support) to help manage these complications.
Trauma & Injuries
Urgent Access & Walk-in Hours
FAAWC understands the challenge of finding foot and ankle care that is quickly accessible. That's why we offer emergency/urgent appointments on an as-needed basis. Please call 740-363-4373 for availability. From noon to 3 p.m. Fridays, FAAWC is open for ANY walk-in patients who do not have a scheduled appointment.
Dr. Anderson: Foot and Ankle Trauma
Sports Injuries Many sports are hard on the feet because of quick and repetitive movements, constricting footwear and/or increased exposure to injury or trauma.
Shin Splints Pain on either side of the leg bone that is caused by muscle or tendon inflammation.
Broken Ankle Can involve one or more of the bones, as well as injury to the surrounding connecting tissues or ligaments.
Ankle Sprains Caused by an unnatural twisting or force on the ankle bones of the foot, which may result in excessive stretching or tearing of one or more ligaments on the outside of the ankle.
Stress Fractures Incomplete cracks in bone caused by overuse. With complete rest, stress fractures in toes or any bones of the foot heal quickly. Extra padding in shoes can help prevent the condition. Left untreated, stress fractures may become complete bone fractures, which require casting and immobilization.
Chronic Lateral Ankle Pain Recurring or chronic pain on the outside part of the ankle that often develops after an injury such as a sprained ankle.
Osteochondritis (stiff ankle) A lesion that usually causes pain and stiffness of the ankle joint and affects all age groups. Osteochondritis is caused by a twisting-type injury to the ankle.
Osteochondromas Benign bone tumors that form in the bone beneath the toenail. Osteochrondromas account for about half of all benign bone tumors, and they occur mostly in children and young adults.
Learn more about selecting the proper athletic shoes with our athletic shoe guidelines.