Calcaneal fractures
When choosing treatment tactics, the following factors are taken into account:
- Cause of fracture
- Your health conditions
- Severity of damage
- Degree of damage to surrounding soft tissues
Since in most fractures of the heel bone it is deformed - widened and shortened - the goal of treatment is to restore the normal anatomy of the heel bone. Treatment outcomes for patients who succeed in restoring the normal shape of the heel bone are usually better. In most cases, the normal anatomy of the heel bone can only be restored through surgery. Your doctor will discuss with you in detail all possible treatment options for your case.
Conservative treatment
Conservative treatment of a calcaneal fracture may be recommended if there is no displacement of the fragments.
Immobilization. External foot immobilization with a rigid cast, splint, or brace helps keep the bones of your foot in the correct position until the fracture heals. Immobilization can last from 6 to 8 weeks, and in some cases longer. During this period, you should not put any weight on the injured foot.
Surgery
If there is displacement of bone fragments, the doctor may recommend surgical treatment of the fracture.
Surgery can restore the normal shape of the heel bone, but it carries the risk of complications, including wound healing problems, infection, and nerve damage. Conservative treatment for some fractures, however, can also cause long-term complications, including pain, degenerative joint disease and lameness. Your doctor will discuss with you in detail the nature of your injury and the risks and benefits of both conservative and surgical treatment.
Timing of the operation. If there is no damage to the skin in the area of the fracture, the doctor may recommend surgery after stopping the soft tissue swelling. Elevating the foot and immobilizing it will speed up this process. This will also allow the skin that is overstretched as a result of swelling to recover a little. Overall, this will speed up your recovery in the postoperative period and reduce the risk of complications.
Open fractures, in which there is communication between the fracture area and the external environment, require emergency surgical treatment, the purpose of which is to clean the wound and remove damaged non-viable tissue.
Early surgical treatment is also recommended for avulsion fractures. Such fractures are uncommon and occur as a result of the traction of the Achilles tendon attached to the heel bone when it is torn from it, dragging a fragment of the heel bone with it. With this type of fracture, as early as possible, even emergency surgery can reduce the risk of skin damage in the Achilles tendon area.
Methods of surgical treatment. For various types of calcaneal fractures, the following surgical treatment methods are used:
- Percutaneous screw fixation. If the size of the bone fragments is sufficiently large, their reduction can be performed without the use of large incisions. To fix the fragments, special screws are used, which are inserted through small skin incisions.
- Open reduction and internal fixation. During this intervention, restoration of the normal shape of the heel bone is carried out openly, i.e. through surgical access sufficient for this purpose. Bone fragments are fixed with knitting needles, metal plates and screws.
(Top) Displaced calcaneal fracture. (Bottom) The fracture has been reduced and secured with screws and a plate.
In this radiograph, the fragments were fixed with a metal plate and screws after reposition.
Calcaneal epophysitis: symptoms and treatment
Children tend to run, jump, and kick the ball around the football field. Unfortunately, this is what causes some of them to develop heel pain. Pain in the foot occurs for various reasons.
The child could get bruised or get a callus. Or it may be caused by a disease of the calcaneus - epophysitis. This is pathology. It is accompanied by an inflammatory process in the distal heels. In this case, the chondral layer may be damaged, which will lead to further ruptures of the fibrous parts of the connective tissue. According to statistics, the majority of patients are boys under fourteen years of age.
Description and causes of the disease
The heel has two centers of ossification. But since bones are just being formed in childhood, they don’t exist as such yet. There are only cartilages. They harden over time and become bones.
One of the ossification centers develops immediately after the baby is born. The other undergoes changes during the first seven years of a child's life. At this time, only cartilage tissue separates them.
Children tend to move a lot. However, due to increased loads, there is a danger of micro-fracture of the connecting fibers. If this happens, inflammation begins. And if the loads do not stop, this process intensifies. Over time, the Achilles tendon becomes inflamed. And if the foot bends incorrectly, an injury results. It is this that opens the way to pathology—epophysitis.
Why does everything happen this way? There is no clear answer. Perhaps these are the consequences of repeated minor injuries received in physical education classes or during various sports games.
The tendency of a certain number of children to develop calcaneal epophysitis for unknown reasons also plays a role. This location, together with stress caused by jumping or running, increases the risk of disease.
The way you move is also important. It happens that children roll their feet excessively on the inside while walking and running. This can lead to weakened and pulled muscles. The result is that the depreciation does not work well, which means microtrauma.
Symptoms
Recognizing the disease is not always easy, because its course is not much different from other inflammations inherent in the heel. You need to start from the fact that the pain is felt precisely on the sides and back of the heel. The pain intensifies when the child runs, jumps and simply walks. Sometimes it hurts even when you touch the inflamed area.
Another symptom is that the movements of the foot become limited. Redness of the skin in the heel area may indicate advanced disease. There is one more detail. The possibility of micro-fractures was discussed above. So, if they exist, then swelling appears and the temperature in the affected node rises.
Because of all this, the patient needs to constantly keep the foot straightened. And this causes a lot of inconvenience, since it greatly limits mobility. But the worst thing is that if for some reason epophysitis is not treated, it can end in lameness. In view of all that has been said, it is obvious that if pain occurs in the heel, you should consult a doctor.
Treatment
Heels are one of the most vulnerable places in a person. They bear the heaviest load while walking or running.
A huge number of capillaries and nerve endings come out here, so self-medication of the pain that arises here is categorically unacceptable. Otherwise, you can get the opposite effect - increased pain.
There are still reasons why it is better to consult a doctor. We saw that it would not be possible to give the correct diagnosis on our own. There are several other rare problems that can also cause heel pain. So, let's go to a pediatric orthopedist.
If the diagnosis of epophysitis is confirmed, you will be advised to ease the load on the epophysis of the child’s heel bone and reduce the tension of the tendons and ligaments attached to it. In other words, you need to provide support for the foot and stabilize the back of it during movement.
There are several means:
- Heel pads;
- Standard insoles;
- Custom insoles.
The effect of individual insoles is determined by the fact that they are made from a cast made according to the shape of the patient’s feet, which means they fully correspond to the shape of the foot of a particular child. Heel pads and standard insoles are not so effective, since they are made according to a standard design and simply cannot fully meet the needs of your child.
After unloading the painful area, so-called conservative treatment is applied. Its task: to reduce swelling and pain. Most often this is:
- Ice cooling;
- Exercises aimed at stretching the Achilles tendon;
- Eliminating inflammation ointments;
- Exemption from physical education.
It is important not only to solve current problems, but also to try to avoid them in the future. To do this, in particular, consult with a podiatrist about the type and quality of shoes the patient wears. It needs to be of high quality and not irritate the foot.
Conclusion
Epophysitis is a disease that can bring a lot of trouble and complicate life already in childhood.
Because of it, children are deprived of the opportunity to actively develop by doing physical education or simply playing with their peers. Do not hesitate to get a medical examination if your child complains of heel pain. Do not waste time and money on treatment. To date, it is believed that there are no long-term complications associated with childhood epophysitis. There will be difficulties if the disease turns out to be advanced. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr
Useful information about foot fractures
The entire foot with 26 bones can be divided into 3 sections: posterior, middle and anterior. The hindquarters consist of the two largest bones of the foot: the talus and calcaneus; The middle section includes the scaphoid bone, three wedge-shaped bones: the first, second, third and cuboid bone. Finally, the forefoot is formed by five metatarsals and 14 phalanges of the toes.
Fractures of the bones of the foot occupy a significant place among injuries to the bones of the skeleton. According to the literature, they account for 17 to 20% of all skeletal bone fractures. The frequency of fractures of the bones of the foot is distributed as follows: phalanges - 74.3%, metatarsal bones - 21.5%, tarsal bones - 4.2%, of which 1.8% are fractures of the calcaneus. The metatarsal bones and phalanges of the fingers are most often injured (73%), with the calcaneus being the second most frequently injured bone.
Hindfoot fractures
These are primarily fractures of the talus and calcaneus, which, of the many bone formations of the foot, are the most important for ensuring the supporting function of the limb. The plasticity and ease of gait are largely due to the correct anatomical architecture of the hindfoot. Any violation of the anatomical integrity of the talus and calcaneus, ligaments, relationships between the articular surfaces of these and nearby bones leads to complete or partial loss of the static-dynamic function of the foot.
Fractures of the talus. Unlike injuries to other bones, they cause severe consequences. The talus, articulating with the articular surfaces of different bones, plays an extremely important role in the biomechanics of the ankle, talocalcaneal and talonavicular joints.
There are fractures of the neck, head, body of the talus, its posterior process, and combined fractures. Fractures of the talus occur mainly when falling from a height onto straight legs. Isolated fractures are rare; in most cases they are combined with compression fractures of the calcaneus and, less commonly, other bones of the foot: navicular, wedge-shaped, metatarsal.
Heel bone fractures. Their distinctive feature is the variety of types of fractures, very different in nature, which makes it impossible to use the standard option for treatment.
As noted, the main cause of calcaneal fractures is a fall from a height onto straight legs (83%), in other cases (17%) fractures occur due to direct impact or compression. In polytrauma, fractures of the calcaneus are most often accompanied by fractures of the ankles, metatarsal bones and spinal injuries. Stress fractures of the heel bones are also common, especially among military recruits and people involved in recreational sports. Unfavorable outcomes from calcaneal fractures are mainly due to the formation of traumatic flatfoot, valgus deformity of the foot, the development of deforming arthrosis in the subtalar joint and, to a lesser extent, osteoporosis, trophic disorders and fibrous changes in the soft tissues of the foot and heel region.
Heel bone fractures are characterized by pain in the area of injury and the inability to put weight on the foot. Noteworthy are valgus and varus deformation of the heel, expansion of the heel area, swelling of the foot, and the presence of characteristic bruises in the heel area and on the plantar surface of the foot. The arches of the feet are flattened. Active movements in the ankle joint are sharply limited due to swelling of the soft tissues and tension of the heel tendon, and are impossible in the subtalar joint.
In the event of a fall from a height and landing on the heel tuberosities, combined damage to the heel bones and spine is possible. Therefore, it is recommended to conduct an X-ray examination even in the absence of complaints in the first days after the injury.
Treatment at the first stage is carried out by a traumatologist. Later, the participation of a rehabilitation doctor is necessary to conduct a full course of rehabilitation treatment