Recovery after a calcaneal fracture

A calcaneal injury affects the patient’s mobility and affects the health of not only the foot, but the entire leg. Reduced physical activity leads to muscle atrophy and negatively affects blood circulation and metabolism. Therefore, we recommend not limiting yourself to just applying a plaster cast, but be sure to consult a doctor who will draw up a program of rehabilitation measures.

Recovery after a heel fracture allows you to avoid a large number of complications, including hallux valgus, metatarsal bone deformity, degenerative changes in the joint, tendon irritation, periodic pain at the site of injury, the appearance of bone spurs, the development of flat feet, osteoporosis, arthritis, etc.

Anatomy of the foot

Let's start by deciphering some terms.

Tarsals are small bones located between the tibia and metatarsus.

Metatarsus - bones of the foot between the tarsus and phalanges.

So, the foot consists of the bones of the tarsus, metatarsus and phalanges of the toes. There are only 27 bones. The rear supporting point of the foot is located in the tarsus, one of the largest and strongest bones in our body - the heel bone. It is attached to the tendons and muscles of the foot. The joint work of tendons, muscles and the bone itself ensures the normal position of the latter and its correct movements when necessary.

In cases of bone fractures, in addition to its anatomical structure, the balance of forces that act on it also changes. As a result, long-term and possibly lifelong functional impairment occurs.

Anatomy of the heel

The heel bone, due to its size, is the largest of all human legs. When in motion, it acts as a sort of springboard for a rebound.

The calcaneus muscle is located under the plate of the foot, as well as under the anterior sagittal and fibrofemoral ligaments. In the posterior part of the bone there is a large tubercle, from which the lateral and medial processes extend. The transverse process connects to the longitudinal plantar ligaments. The medial process connects to tendons that allow the fingers to move.

Symptoms and causes of heel fractures

The main cause of fractures of one of the strongest bones in our body is a jump from a height onto straight legs. In other cases, the cause of such injury, as a rule, is road traffic accidents or blows to the heel area. It is worth noting that due to the fact that the heel bone is unusually strong, its fracture is most often accompanied by fractures of other bones of the body: the ankle, thoracic and/or lumbar vertebrae.

Separately, we can distinguish the so-called stress fractures of the calcaneus. They can be found among soldiers who have recently enlisted in the army, as well as among non-professional athletes.

Accompanied by fractures of the calcaneus:

• pain in the heel area;
• inability to step on the heel;
• heel deformation, swelling;
• hemorrhage in the heel area may also indicate a possible bone fracture;
• the ability to move the ankle joint is limited.

How does such a fracture occur?

Almost 83% of cases of heel fractures occur when people fall from a height and land on straight legs. And the remaining 17% comes from impacts and squeezing. Polytraumas of the heel are extremely rare.

Symptoms:

- A person feels a sharp pain in the heel - It is impossible to step on the foot - Valgus and varus deformation of the heel is visible - The foot swells - The heel area is expanded - There are bruises on the sole of the foot and on the heel.

Diagnostics:

To determine which fracture is present, an x-ray is taken, and the height, angle of inclination, and length of the heel bone are also determined.

Diagnosis of calcaneal fractures

One of the simplest and most common methods for diagnosing calcaneal fractures is radiography in two projections. In controversial cases, a repeat radiograph is performed 7-10 days after the injury, during the period of resorption of the fracture site, when the fracture becomes more clearly visible.

Or a computed tomography scan is performed. which displays the bone structure in more detail. As a rule, it is resorted to in difficult cases, to determine the tactics of surgical treatment: how many bone fragments, what type of fixator to choose?!

Calcaneus

The human foot consists of more than 26 bones, the largest of which is the heel bone. It provides rigid support for the entire body. When we move, the heel bone absorbs the force when it hits the ground. When walking, the pressure of body weight can be 1.25 times greater than when standing, and when running - more than 3 times.

The heel bone has an extremely strong outer layer of bone material that surrounds an inner layer that is quite loose and soft.

We can confidently assume that the heel bone experiences the most significant loads and, therefore, the heels are most vulnerable to damage and, as a result, pain.

Heel bone: Types of damage

1. FRACTURE OF THE CALENA BONE - due to significant physical activity, injury or osteoporosis.

Causes of calcaneal fractures

The main cause of fractures - more than 70% of injuries to the heel bone - is injury when landing on the feet as a result of a fall on a hard surface. The height and speed of the fall determines the amount of traumatic energy, and the position of the foot at the moment of landing determines the type of fracture. “Low-energy” impacts usually lead to fractures without displacement or with minor displacement of bone fragments, while “high-energy” impacts lead to comminuted fractures with possible significant displacement. The valgus position of the foot at the time of injury determines the position of the primary bone fracture line in the lateral (posterior) part of the bone, and the varus position - in its medial part.

Symptoms of fractures

When the calcaneus is fractured, patients complain of pain in the heel area. Upon examination, swelling in the heel area, up to the Achilles tendon, deformation of the heel, as well as a hematoma in the center of the sole are usually detected. Palpation of the injury area is very painful, and supporting the leg causes sharp pain. In case of fractures of the calcaneus only, the mobility of the ankle joint is preserved. To confirm the diagnosis and clarify possible displacement, it is necessary to take x-rays in three projections.

Types of calcaneal fractures

Fractures of the heel bones can be compression, isolated, marginal, without displacement or with displacement of heel bone fragments. The severity of the injury directly depends on the force that was applied to the bones.

2. PLANTAR FASCITIS (plantar fasciitis), achillodynia - a tear of the plantar ligament or Achilles tendon, often accompanied by inflammation of the fascia.

The plantar fascia is a strong ligament that connects the heel bone to the end of the foot. With plantar fasciitis, soft tissues most often become inflamed at the point of their attachment to the heel bone. This is where the bone growth grows.

The patient experiences pain in the heel, especially after sleep or rest - the so-called “starting pain”. More about plantar fasciitis

Plantar fasciitis is usually successfully treated with Shock Wave Therapy in 5-6 sessions.

3. CALANCAL BURSITIS - inflammation of the back of the heel with the formation of a fibrous sac with joint fluid. The pain is usually felt at the back of the heel. Sometimes the Achilles tendon may also swell. Unlike plantar fasciitis, there is virtually no “starting pain”, and pain in the heel area usually gets worse throughout the day. Read more about bursitis ... A calcaneal cyst is the appearance of a single fluid-filled cyst (cavity) in the bone. 4. EPIPHYSITIS OF THE CALEAN BONE - inflammation of the posterior edge of the heel bone due to circulatory problems (most often in children from 6-14 years old).

Calcaneal fractures treatment

Non-surgical Treatment If, due to trauma, the bone fragments have not been displaced from their original position, then it will be possible to do without surgical treatment using a fixator, orthosis or immobilizer. This will allow the broken ends to be secured in the proper position for splicing. You will not be able to put any weight on your foot until the bones are completely fused. This may take 6 to 8 weeks, maybe longer. Surgical Treatment If the bones are displaced, then surgery may be required. Timing of surgery. If the skin around the fracture is intact, your doctor may recommend that you wait to have surgery until the swelling has subsided. Open fractures require immediate surgery

If you feel pain in your heel while walking, consult a doctor rather than self-medicate. Remember: heel bone fractures and plantar fasciitis are treated much more effectively at the initial stage. By contacting our Clinic, you will receive adequate treatment, which will result in relief from long-term, sometimes long-term pain.

Interested in learning more about shock wave therapy treatment for plantar fasciitis or achillodynia? To search for materials in the search module or on the site map, use the terms: calcaneus , plantar fasciitis treatment , treatment of plantar fasciitis, plantar fasciitis symptoms, plantar fasciitis treatment, plantar fasciitis photo, plantar fasciitis treatment, Moscow, Bibirevo, Otradnoe, Altufyevo, Timiryazevskaya, grandma's.

Treatment of calcaneal fractures

The treatment method depends on the complexity of the heel fracture, the condition of the patient, and whether there are concomitant fractures or diseases.

• For fractures without displacement or damage to the joints, immobilization is performed using a plaster splint with an instep support. In this case, putting pressure on the leg is prohibited for 4-6 weeks, and the plaster is removed after one and a half to two months.

• In the case of a displaced fracture, but without damage to the articular surface, manual reduction is performed (under local or local anesthesia with pain relief), followed by the application of a special bandage with a metal arch support and stirrup. In this case, weight bearing on the leg is prohibited for 8 weeks, and the cast is removed after 2 months.
• A fracture of the calcaneus with displacement and damage to the joint requires mandatory reduction and the use of skeletal traction. Traction lasts about one and a half months, after which a plaster cast with an instep support is applied for a period of up to 3 months. Or an operation to install a plate to fasten the fracture in an anatomically correct position.

Types of surgery

Medical practice has developed two types of restoration of the calcaneus after a traumatic fracture. Depending on the type of damage to the heel bone, the following types of surgical treatment are used:

• Percutaneous screw fixation method. Used in the presence of large bone fragments. In this case, reduction can be performed without large incisions. Small incisions are used to insert special mounting screws inside.
• A method of open reduction of internal fixation, when the normal shape of the heel bone is restored using open access. Fixation is performed using knitting needles, screws, and metal plates for a heel fracture .

The decision to use one or another type of treatment for an injury is made by the attending physician, according to the results of the examination of the patient.

Rehabilitation period after a heel fracture

The duration and complexity of the rehabilitation period are determined by the nature of the heel bone fracture and the individual characteristics of the human body. For some patients, the rehabilitation period will take no more than 2-3 months, while others may need 2-3 years to recover. As a rule, the first movements of the foot are allowed only after the pain has completely disappeared. After this, the physiotherapist prescribes certain exercises and a special massage. The patient is recommended to wear orthopedic shoes for 6 months. It is important to carry out all the doctor’s recommendations during the rehabilitation period gradually and in doses, since excessive zeal in performing exercises can provoke secondary displacement of the bones, and as a result, additional problems.

Don't self-medicate!

Only a doctor can determine the diagnosis and prescribe the correct treatment. If you have any questions, you can call or ask a question by email.

Performing osteosynthesis surgery

During the operation, the patient is given general anesthesia. The patient is placed in the lateral position, and the surgeon makes an incision. The incision can be made on the outside of the foot, L-shaped, or oblique. An oblique incision is rarely used to avoid complications in the form of tissue necrosis due to impaired blood supply to them. After making an incision, the surgeon moves aside the skin, muscles, and tendons. The doctor then gains access to the bone and joint.

The process of restoring the heel bone is more difficult, the more small fragments are formed as a result of the injury. To restore the shape of the heel, in accordance with the anatomical norm, it is necessary to perform temporary fixation of the fragments. Usually, when a heel is fractured, two larger elements are formed; they must be connected and fixed temporarily. After this, the surgeon collects small pieces, restoring the shape of the heel bone and joint. All fragments are fixed with temporary fastening until complete reconstruction. In some cases, a fracture may accompany damage to the calcaneocuboid joint. It is also being reconstructed. a special plate and heel installed instead . At the end of osteosynthesis, sutures are placed on the incision.

Rehabilitation

After a heel fracture, rehabilitation is mandatory. This is necessary because over a long period of immobilization of the foot, the muscle tissue has weakened significantly.

During the rehabilitation period, recovery is carried out using the following procedures:

• Physiotherapy. It includes participation in sessions of electrophoresis, lightning therapy and quartz treatment (UVA). shock wave therapy;
• Massotherapy;
• Classes in the physical therapy room (physical therapy). In order to warm the feet, special exercises are done. Patients are also advised to exercise lightly on an exercise bike.

These measures allow you to speed up the process of restoring the elasticity of muscle tissue, as well as prevent the formation of blockages. The duration of rehabilitation after a heel fracture depends on the complexity of the pathology and the characteristics of the patient’s body. The minimum rehabilitation period after such an injury is 2-3 months.

It is important that the patient eats properly during the recovery period. Your daily diet should include fermented milk products, as well as products containing gelatin and calcium. Food should be rich in vitamins E, C and D.

Also, in most cases, 5-6 months after a heel fracture, the patient is shown orthopedic shoes.

Heel fracture: complications

If treatment is started too late or incorrectly, a heel fracture can lead to a number of complications:

• Development of osteoporosis;
• Flat feet;
• The occurrence of lameness and curvature of the foot;
• Arthrosis of the lining joint;
• A hallux valgus deformity in which the foot tilts to the side in an "x" shape.

If a heel fracture is not treated properly, complications can occur, including flat feet.

There is also a risk of permanent deterioration in the support function of the injured foot if treatment is not correct or if healing procedures are not followed properly.

Prevention

To prevent this type of injury, general safety rules must be followed:

• Before intense exercise, you should do a thorough warm-up;
• Do not jump from great heights;
• For all types of jumps, land with your feet together and your knees slightly bent;
• Only suitable shoes should be worn when running or exercising. Shoes with thin soles are not suitable for sports;

Do not run or jump on hard surfaces. Asphalt is also not suitable for running.