Introduction
A calcaneus fracture, also known as a heel bone injury, can seriously impact your mobility and may need surgery to get you back on your feet. Dr. Nick Argerakis is a board-certified foot and ankle surgeon who specializes in helping patients get back to their normal, active lives. Book your appointment today by calling (732)-320-9173.
Key Takeaways:
- Calcaneus fractures, or heel bone fractures, often result from high-impact trauma like falls or car accidents.
- Surgery may be necessary to restore the alignment and function of the heel when the fracture causes significant misalignment.
- Heel fractures are often caused by accidents like falling from a height, being in a car crash, sports-related injuries, or even weakened bones due to conditions like osteoporosis.
- To diagnose a calcaneus fracture, doctors usually start with a physical exam and X-rays, and they might recommend a CT scan for a clearer picture of the injury.
- Surgery for a heel fracture typically involves either open reduction and internal fixation (ORIF) or less invasive methods, depending on the injury.
- Recovery is lengthy, involving immobilization, physical therapy, and possible long-term stiffness or arthritis.
- Risks include infection, wound healing issues, and potential nerve damage, but consulting an experienced surgeon can improve outcomes.
What Is Calcaneus Fracture Surgery?
The calcaneus is the largest bone in the foot, playing a vital role in supporting body weight and enabling movement. A fracture of this bone can severely affect mobility. The main purpose of calcaneus fracture surgery is to put the broken bone pieces back in place, reshape the heel, and help you move comfortably again. Surgical intervention is often recommended when the fracture results in significant misalignment or disruption of the bone’s natural structure.
What Causes Calcaneus Fractures?
These fractures usually happen because of high-impact injuries, like a heavy fall or another forceful blow to the heel. Common causes include falling from a height, such as a ladder or scaffolding, and landing directly on the feet. Car accidents, particularly those where the foot is forcefully pressed against the brake pedal during impact, are another frequent cause. Sports injuries and severe twisting motions of the foot can also result in such fractures. Additional risk factors may include osteoporosis or other conditions that weaken bones, making them more susceptible to breaking under stress.
Types of Calcaneal Fractures
Heel fractures are classified by whether or not they involve the joints near the heel:
- Intra-articular fractures: These involve the subtalar joint and nearby joints, often accompanied by damage to the cartilage, which serves as a cushion between bones. Recovery outcomes depend on the extent of crushing sustained by the calcaneus during the injury.
- Extra-articular fractures: These fractures occur outside the joints and generally have a more favorable recovery. Surgical treatment is rarely necessary for this type of fracture.
How Is a Calcaneus Fracture Diagnosed?
Doctors usually diagnose a heel fracture with a detailed physical exam and imaging tests, like X-rays or CT scans. Standard X-rays are usually the first step in assessing the extent of the injury. In cases where more detailed information is needed, a CT scan is performed to identify the type, pattern, and classification of the fracture. Surgery is generally advised if imaging shows that the bone’s alignment has been compromised. However, surgery may not be necessary if the heel’s shape remains intact, and the alignment is adequate.
Certain factors may affect the decision to proceed with surgery. Patients with diabetes, smokers, or individuals with poor blood flow are at a higher risk of complications like infection and delayed healing. Elderly individuals or those taking medications such as steroids may also face challenges during surgical recovery.
What Are the Surgical Treatment Options?
Heel fracture surgeries aim to reposition the bone fragments and secure them in place using medical hardware such as plates and screws. The two main surgical approaches are open reduction and internal fixation (ORIF) or a less invasive option called closed reduction with percutaneous fixation.
In the traditional open procedure, the surgeon makes a hockey stick or “L”-shaped incision on the heel to access the fracture. Nerves and tendons are carefully moved aside to allow the surgeon to realign the bone fragments. Temporary wires may be used to hold the pieces together before placing plates and screws to secure the alignment permanently.
The closed reduction technique involves smaller incisions and uses X-ray guidance to realign the bone fragments. Screws are then inserted through the skin to stabilize the fracture. This minimally invasive approach is typically chosen when the fracture pattern allows for less extensive surgical intervention.
Specific Surgical Techniques
Calcaneus fracture surgery is done under general anesthesia, with an additional nerve block to help manage pain for the first 12-24 hours after the procedure. A tourniquet is used to limit bleeding, giving the surgeon a clearer view during the operation. The broken bone pieces are carefully realigned and held in place with plates, screws, or other hardware to restore the natural shape and function of the heel.
Once the bone is stabilized, the incision is closed with stitches, and a cast or splint is applied to protect the area and reduce swelling. The type of surgery and the hardware used depend on the complexity of the fracture and the condition of the surrounding skin and soft tissues.
What Is the Recovery Process?
Recovering from calcaneus fracture surgery requires time and effort. At first, the foot will be in a cast or boot to keep it immobilized and allow the bone to heal properly. During this period, you’ll need to avoid putting any weight on the injured foot for about 6-8 weeks.
Physical therapy plays a key role in recovery. Once your doctor confirms that the bone is healing well, therapy will help you regain strength, flexibility, and range of motion in the foot and ankle. However, it’s normal to experience some stiffness or a slight loss of motion after surgery.
In some cases, arthritis may develop in the affected joint, especially if the fracture involved the joint surface or wasn’t perfectly realigned. If arthritis becomes severe, additional treatment or even surgery may be needed to manage pain and restore function.
What Are the Risks and Complications?
As with any surgery, calcaneus fracture repair comes with risks. These can include infection, nerve or blood vessel injuries, and anesthesia-related complications. Specific to this type of surgery, issues like delayed wound healing or temporary nerve irritation may arise. The good news is that nerve problems often improve with time, and proper wound care can reduce the risk of infection.
Long-term complications like arthritis are fairly common, as they usually result from the initial injury rather than the surgery itself. If arthritis develops and causes significant pain, options like joint fusion surgery can help.
Conclusion
Calcaneus fracture surgery is a complex procedure aimed at restoring the heel’s alignment and function after a serious injury. While it offers significant benefits, the recovery process requires patience and dedication. Consulting with an experienced surgeon is essential to ensure you receive the best possible care and outcome.
If you’re dealing with a heel fracture or experiencing related symptoms, don’t wait to get help. Reach out to Dr. Nick Argerakis today to discuss your options and start your recovery journey.
