CALCANEUS FRACTURE OR BROKEN HEEL BONE

Calcaneus Fracture Causes

A calcaneal fracture occurs when the heel bone gets crushed against the talus by excessive force (the lowest bone of the ankle). The subtalar joint connects the calcaneus and the talus and is an important component of flexing, standing, and walking. It also couples with the ankle joint for dynamic motion. This joint frequently becomes involved in these types of fractures, which can result in long-term joint problems such as chronic pain, stiffness, and the development of arthritis.

Calcaneal Fractures rarely have a clean break like an arm or leg, and therefore, doctors find them difficult to treat. Parents should consider taking their child to experts like us who know how to treat this condition.  We consider the calcaneus as an egg with an intact shell that is difficult to break when squeezed in the palm. However, if there is any defect or crack in the surface, any abnormal pressure on the shell will cause it to crumble because the center is soft and sponge-like. When the calcaneus fractures, the hard outer layer can split into multiple irregular fragments and fold in on itself, similar to an egg with a cracked shell.

Calcaneus Fracture Diagnosis

Consult our pediatric orthopedic specialists if your child has recently suffered a trauma and is experiencing symptoms of a calcaneal fracture. Our doctor will examine your child’s foot for swelling and other signs of a fracture or joint damage. X-ray imaging can aid in the diagnosis process. Our doctor may also order a CT scan to determine whether surgery is necessary based on the pattern of the fracture.

Depending on the cause of the injury, our children’s specialists may also examine your child for an ankle or mid-foot injury. A lumbar spinal burst fracture affects about 10% of patients who have calcaneal fractures. When a vertebra in the lower-mid back becomes crushed, there is back pain. Please notify your doctor if your child suffers from back pain.

Calcaneus Fracture Treatment Options

Calcaneal fractures appear challenging to treat. The heel bone is shaped like an egg, with a tough exterior and a soft interior. As a result, when traumatized by a fall or accident, the heel bone frequently shatters. As a result, treatment necessarily requires the repair of multiple fractures in the heel bone as well as the recovery of the subtalar joint. The subtalar joint connects the calcaneus to the talus, the small bone that connects the heel to the leg. Given the location of the joints, it holds the majority of the body’s load.

Rest and partial to total immobilization can help the bone mend if the fracture hasn’t caused it to move. A cast will immobilize the heel. The patient’s age, fracture severity, and overall health will determine the length of time it takes to heal. Some of these fractures can take up to 6 months to heal.

Immobilization

Our doctors may cast the injured foot to keep the fractured bone from moving. They will also recommend your child use crutches to avoid bearing body weight until healing has occurred.

R.I.C.E

Rest, ice, compression, and elevation (R.I.C.E.) is the most commonly recommended treatment. The fracture heals by resting the injured foot. Ice packs will reduce swelling and pain by placing them on the affected area and covering them with a towel. Patients can reduce swelling by wearing compression stockings or elastic bandages and elevating their feet above their heart level.

Pain medication

Our doctor may also prescribe a nonsteroidal anti-inflammatory drug (NSAID) pain reliever such as ibuprofen (Advil, Motrin). These medications can help with pain as well as other symptoms like swelling and bruising. Because calcaneus fractures can be incredibly painful, our doctor will work closely with the parents to manage their child’s pain.

Physical therapy

Depending on the extent and severity of your child’s fracture, as well as the stability of the calcaneus, recovery can take months or years. The involved ligaments and tendons may take even longer to heal. Doctors may recommend physical therapy to aid in your recovery. After the bones have healed sufficiently, stretching exercises within a physical therapy/rehabilitation program will help restore the range of motion, strength, and stability of your child’s heel bone.

Elevation

Elevate your child’s heel above the heart as often as possible. This will aid in the reduction of swelling and pain. Prop your child’s leg up on pillows or blankets to keep the heel comfortably elevated.

Surgical Treatment

A calcaneal fracture requires an extremely skilled surgeon and is inherently risky. Our surgeon will restructure the heel bone to resemble its original shape. Because each fracture is unique, each surgical procedure is highly customized. Typically, surgery cannot begin until the swelling has calmed down, which takes about 10-14 days after the trauma. Operating on an extremely swollen foot can cause healing issues and increase the risk of infection. In most cases, the surgery is performed through an open incision on the outside of the heel. The surgeon then carefully repositions the fragments and secures them with screws and metal plates.

Timing of surgery

If the skin around your child’s fracture has not been broken, our doctor may advise the parent to wait until the swelling has gone down before undergoing surgery. Elevating your child’s leg and immobilizing it for several days will help to reduce swelling. It will also give the injured skin time to heal. Waiting before surgery may improve the overall recovery and reduce the risk of infection.

Surgical procedure

The following surgical procedures are used to treat various types of calcaneus fractures:

Percutaneous treatment

Percutaneous treatment: This is a minimally invasive surgical technique for a small percentage of fractures. The surgeon makes a small incision and uses a surgical wire to pierce the broken bone fragments. The surgeon can then manipulate the bone fragments back into place. If the bone fragments are large enough, doctors can sometimes reposition them without having a large incision. To hold the fracture together, surgeons insert special screws through small incisions.

Internal fixation and open reduction. The surgeon will make an open incision during this procedure to reposition (reduce) the bones into their normal alignment. Wires or metal plates and screws hold them together. Bones have an amazing ability to heal. However, the more severe the injury, the longer the recovery may be. Patients with more severe fractures are also more likely to experience some level of permanent functional loss, regardless of treatment.

Calcaneus Fracture Rehabilitation 

Whether the treatment for a calcaneal fracture becomes surgical or non-surgical, physical therapy will help the child regain strength and function.

Calcaneus Fracture Complications

Infection

Unfortunately, this is possible.  Doctors may prescribe Oral antibiotics to treat mild cases. In more severe cases, the entire surgical procedure may be compromised, requiring the removal of all hardware as well as any infected tissue or bone.

Subtalar arthritis

Subtalar arthritis is a chronic pain condition that most commonly affects people who have healed calcaneal fractures. If this happens, your child may need to have an additional procedure to fuse the affected joints, which is most commonly the subtalar joint, at some point.

Nerve damage

Permanent numbness at the surgical site is possible. The sural nerve (which runs through the incision site) can become entrapped in scar tissue and become quite painful in some cases.

Non-union

The bone does not always heal. If this is the case, a non-invasive bone growth stimulator may be beneficial. In more severe cases, additional surgery may be required to help the bone resume normal healing.

Why Should You Choose Us to Treat Your Child’s Broken Heal Bone

Since its beginning, Medical City Children’s Orthopedics & Spine Specialists, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX have been known for providing outstanding pediatric orthopedic care. In addition, families visit from all over the world to visit our specialists. Our children’s specialists have the training and expertise to detect even the most unusual medical problems in children. We collaborate to develop a tailored treatment plan once we’ve diagnosed your child’s ailment.

After implementing treatment, our world-renowned pediatric orthopedic experts, Dr. Kishan, Dr. Hostin, or Dr. Wiesman, will closely monitor each patient.  Because broken bones may growth problems in kids, our medical practice has built one of the world’s leading pediatric imaging programs to track and quantify changes in children’s bones and bodies.

Care and Service

Finally, our care navigators organize appointments because most children need to see many doctors and may require multiple treatments. We also assist children with achieving the maximum potential function and quality of life by providing access to Medical City specialists and support services, such as:

• Our Fracture Care Clinic to medically repair the broken heel
• Support services.

If you have any questions or need to make an appointment, please call us at 214-556-0590

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Footnote:

American Academy of Orthopaedic Surgeons: Heal Bone Fracture