The most common cause of a Calcaneus Fracture is a fall from a balcony, ladder, table or window. Most extraarticular fractures are treated conservatively with 10-12 weeks of casting (true extra-articular fractures only account for roughly 20% of all calcaneal fractures). The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. 1998; [PubMed PMID: 9801778], Benirschke SK,Sangeorzan BJ, Extensive intraarticular fractures of the foot. Displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. Review the evaluation of a patient with a calcaneus fracture. Overall the outlook for patients with calcaneus fractures is guarded. 2004 Jan; [PubMed PMID: 14676550], Siebert CH,Hansen M,Wolter D, Follow-up evaluation of open intra-articular fractures of the calcaneus. 2022 Aug 8. Copyright 2015 - 2022 Adam D. Perler, DPM, FACFASSite Design by Swarm Interactive, Heel Bone Fractures (Calcaneal Fractures), Extensive swelling and bruising in the heel region. Although screws are thought to provide greater stability . Twenty-one fractures were included in this series and the authors found that calcaneal length, height, and axial alignment can be restored with an external fixator, Bohler's angle cannot be restored with external fixator and ligamentotaxis alone. The authors had no deep or superficial wound infections requiring surgical intervention, which is promising but the authors simultaneously cautioned against drawing conclusions from such a small and limited series without statistical power or a control group. The hindfoot articulates with the tibia and fibula creating the ankle joint. government site. These injuries are also closely associated with the development of post-traumatic arthritis of the subtalar joint (rearfoot). Combined ipsilateral fractures of talus and calcaneus. A temporary reduction may be maintained by the placement of Kirschner wires through this tuberosity fragment into the "constant" fragment of the medial sustentaculum. [30]This is considered post-traumatic arthritis. Here are some of the causes of a calcaneus fracture. [24]One hundred and thirty-nine tongue type fractures were reviewed at a single institution over a 5 year period and found an overall rate of 21% soft tissue compromise, further finding that fractures with greater initial displacement were at a greater risk of skin compromise. There are two main categories of Calcaneus Fracture. Correct diagnosis and workup must include orthogonal X-Rays, specialized views, and a CT scan is considered the gold standard for a complete diagnosis. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Calcaneus fractures are rare but potentially debilitating injuries. Icing. An extraarticular fracture accounts for 25% of all Calcaneus Fractures, while intraarticular fractures account for 75%. It included a total of 151 patients with 73 in the operative arm and 78 in the non-operative arm. In patients with identifiedthreatened soft tissueupon presentation treated with emergent operative reduction and fixation none went on to further soft-tissue complications[24]. Gravity. [12], A more recent meta-analysis from 2017composed of 18 trials including 1467 patients found significantly improved anatomical improvements with operative intervention with regards to the restoration of Bohler's angle, calcaneal heights and widths as well as the likelihood of resuming former work. It allows for adequate visualization intra-operatively and allows for manipulation of the fracture to restore alignment and articular surfaces. 2008 Aug [PubMed PMID: 18670282], Buckley R,Leighton R,Sanders D,Poon J,Coles CP,Stephen D,Paolucci EO, Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of Sanders type IV calcaneal fractures: a randomized multicenter trial. Acta radiologica (Stockholm, Sweden : 1987). Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. A two year recovery, with a stiff, painful, deformed foot that will not fit into a normal shoe and osteoarthritis of the subtalar joint are common outcomes.1, Orthopaedic surgeons often fix these fractures internally to try to improve the final result. Archives of orthopaedic and trauma surgery. Federal government websites often end in .gov or .mil. Most calcaneal fractures are occupational, and are caused by axial loading from a fall [ 2 ]. Pain in the heel, with diffuse tenderness on palpation of the heel Swelling Plantar ecchymosis Please note that narcotics in our practice are extremely restricted and are NOT a good long term solution. Adjunctive percutaneous screws are often placed to assist with the other parameters of calcaneal morphology including height, width and hindfoot alignment. Plantar ecchymosis extending through the plantar arch of the foot should raise suspicion significantly. Radiographics. After surgery complications are common and may include compartment syndrome, osteomyelitis, wound infection malunion and subtalar arthritis. [14], Surgical intervention is typically recommended for the following indications:[15]. Historically a burst fracture of the calcaneus was coined a "lovers' fracture" as the injury would occur as a suitor jumped off a lover's balcony to avoid detection. 2019 Apr;36(2):211-224. Some have more simple patterns that do not involve the joint and usually heal without any long term issues while others are more complex with fragment displacement and extend into one of multiple joints and are very challenging to get to heal properly, often requiring surgical intervention to optimize healing. You doctor will evaluate your foot for swelling and other signs of a fracture or joint damage. Those with an isolated fracture do recover with time but those with a concomitant injury . 2008 Mar;29(3):318-24. doi: 10.3113/FAI.2008.0318. American volume. Feel free to get in touch with us and send a message. They found that despite a higher complication rate than closed calcaneal fractures treated operatively the complication rate in their paper was not as high as had been previously reported in the literature. These fractures will heal if treated non-operatively, but patients can be left with persistent deformity, incongruent joint surfaces, and loss of alignment of the leg to the heel. You can download a PDF version for your personal record. The wound complication rate was 29% in the extensile lateral group with 9% of the total treated cases requiring repeat surgery for those complications. [23], Some authors have adopted a two-stage surgical approach for severely displaced closed calcaneal fractures to try to mitigate the issue of soft tissue compromise. Smokers, elderly patients, and patients with diabetes or vascular disease may be at higher risk for surgical complication, such as an infection or blood loss. A temporizing measure is typically to place a removable posterior splint in plantarflexion with close skin monitoring until definitive treatment. Surgical treatment must be delayed until the so-called, "wrinkle sign," returns. . 2019 Oct [PubMed PMID: 31921576], Albin SR,Koppenhaver SL,Marcus R,Dibble L,Cornwall M,Fritz JM, Short-Term Effects of Manual Therapy in Patients After Surgical Fixation of Ankle and/or Hindfoot Fracture: A Randomized Clinical Trial. [14]. The closure is typically recommended with an interrupted Allgwer-Donati stitch to try to relieve tension on the incision itself. [1][2][3]. Once the patient and the surgeon have determined to proceed with surgical treatment the goals must include adequate reduction of articular surfaces and restoration of calcaneal morphology. Clinics in podiatric medicine and surgery. Tarsal fractures account for 2% of all fractures. Routine serial radiographs should be obtained to ensure the progression of healing. 2019 Apr; [PubMed PMID: 30784536], Hordyk PJ,Fuerbringer BA,Roukis TS, Clinical Management of Acute, Closed Displaced Intra-Articular Calcaneal Fractures. The extensile group's fracture composition was 53% Sanders II and 47% Sanders III. A calcaneal stress fracture is one or more small breaks in your heel bone (calcaneus). The operative group was treated as described below with the extensile lateral approach and the non-operative group was treated with initial immobilization followed by gentle mobilization as allowed by pain. The peak incidence occurs in younger males [ 2 ]. Physical Therapy can last for 4-6 weeks depending on the cause of injury. Severe heel bone fractures can extend into the ankle joint and fracture the cartilage that . A patient may notice swelling and heat around their heel bone, and there may be subtle bruising on the heel bone. Subfibular impingement may result in lateral heel pain, particularly with eversion of the hindfoot. Wrap your heel in a compression sock or ace bandage. STUDY. 2019 Apr; [PubMed PMID: 30784540], Cottom JM,Douthett SM,McConnell KK, Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. [15]. You may see blisters form. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. The Journal of bone and joint surgery. A general pain in the heel that gradually worsens could be a sign of a stress fracture. The Journal of the American Academy of Orthopaedic Surgeons. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. [18]The lateral calcaneus and joint surfaces can be well visualized and typically temporary retraction is created by the placement of Kirschner wires into the talus, fibula, and cuboid. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 2019 Feb 13; [PubMed PMID: 30759357], Toro G,Langella F,Gison M,Toro G,Moretti A,Toro A,Iolascon G, Stentoplasty of calcaneal fractures: Surgical technique and early outcomes. 2017 Feb [PubMed PMID: 28129268], Hsu AR,Anderson RB,Cohen BE, Advances in Surgical Management of Intra-articular Calcaneus Fractures. FOIA Typically, non-surgical treatment involves: Surgical correction of a fractured heel bone is a risky procedure. Falls. The meta-analysis did confirm the higher complication rate of operative intervention but concluded that operative treatment of displaced, intra-articular calcaneal fractures has better anatomic recovery, functional outcomes and return to work. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. Patients must be counseled that there are advantages and disadvantages to surgical treatment. If you have a subscription to The BMJ, log in: Subscribe and get access to all BMJ articles, and much more. Your doctor may also order a CT scan to get a better idea of the pattern of the fracture, to determine whether surgery is needed. Overall, they screened 2006 patients with calcaneal fractures, of whom a quarter (n=502) were eligible . Calcaneus fractures are a severe and life-changing injury. Medicine. The patient should be adequately educated on the need to elevate the extremity for the first several weeks after surgery to reduce swelling and the subsequent risk of wound complications. The https:// ensures that you are connecting to the This will typically on hurt during activity and gets better with rest. [26], The Sanders classification has been found to have sustained prognostic value. 2020 Mar - Apr [PubMed PMID: 32131003], Kline AJ,Anderson RB,Davis WH,Jones CP,Cohen BE, Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. 2015 Jul [PubMed PMID: 26111874], Seat A,Seat C, Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. The splint may be removed as early as 2-5 days based on some recommendations or left in place for 2 weeks in some cases, but after removing the splint the patient should begin his or her range of motion exercises for the subtalar joint and ankle joint as soon as possible. Care must be taken to ensure one does not over-penetrate the medial cortex. Level 1 evidence supports theAllgwer-Donati stitch's use over the vertical mattress suture in lower extremity trauma as theAllgwer-Donati yields improved tissue perfusion at the incision site. However, a recent meta-analysis was performing comparing minimally invasive techniques with the standard lateral extensile approach. 2022 May 29. A calcaneal fracture occurs when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle). All patients who are candidates for outpatient treatment are non-weight bearing at discharge. British volume. jsandoe. Symptoms of a Calcaneus Fracture include pain when weight bearing on the heel that is worse with impact activity such as walking, running or jumping. Treatment for Calcaneus Fracture is decided based on the type and location of the fracture. The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. 2018 Aug; [PubMed PMID: 30095652], Csizy M,Buckley R,Tough S,Leighton R,Smith J,McCormack R,Pate G,Petrie D,Galpin R, Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. However, they are also seen in long-distance runners, ballet dancers and sports involving jumping. The calcaneus is the most fractured of all tarsal bones. Traditionally, a burst fracture of the calcaneus was known as "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony (axial loading) to avoid detection. Furthermore, all serous and hemorrhagic blisters must be epithelialized. If you are unable to import citations, please contact Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. There are two main classification systems of extraarticular fractures. Arthroscopy techniques. Foot Ankle Int. If this test is positive for pain, it is likely that you will be referred for an x-ray. Tarsal fractures account for roughly 2 percent of all fractures in adults. Surgical treatment tends to fall into one of two categories, the open extensile lateral approach, and minimally invasive techniques. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. When surgical management is recommended it is with the goal to restore calcaneal morphology and to restore articular congruency. He offers Online Physiotherapy Appointments for 45. -. Calcaneus fractures are rare in children They usually occur from a fall from a significant height with axial loading of heel, injuries to the foot involving motorized vehicles or from direct blows to calcaneus. Calcaneus Fracture Diagnosis. Heel Bone Fractures (Calcaneal Fractures) Rearfoot fractures of either the heel bone (calcaneus) typically occur after a high impact/velocity injury, such as a fall from height or motor vehicle accident. 2010 Mar [PubMed PMID: 20194342], Buckley R,Tough S,McCormack R,Pate G,Leighton R,Petrie D,Galpin R, Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. Reduction and alignment should be verified with fluoroscopy and exchanged for definitive fixation and the wound should be closed in layers with many recommending drain placement. All participants of the study recovered very slowly from injury, most improvement plateaued at 18 months and most participants reported ongoing adverse effects from their injury at 2 years. It is part of the hindfoot and sits directly below the three bones that make up the ankle joint. 2019 Apr; [PubMed PMID: 30784532], Herrera-Prez M,Oller-Boix A,Valderrabano V,Gonzlez-Casamayor S,Gutirrez-Morales MJ,Guerra-Ferraz A,Pas-Brito JL, [Calcaneal fractures: controversies and consensus]. This joint is often involved in these types of facture which can lead to long term problems with the joint such as chronic pain, stiffness and the development of arthritis. 2013 Jun [PubMed PMID: 23460669], Li LH,Guo YZ,Wang H,Sang QH,Zhang JZ,Liu Z,Sun TS, Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients. -, Schepers T. Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. Alignment is still evaluated under fluoroscopy. [32] This may result from direct damage to the tendons themselves as a result of the injury or fracture fragments that may impinge on the tendons. The risk is reduced with a more inferiorly based L-incision. The fracture lines are opened at this time and may include temporary removal of the lateral wall. A heel bone fracture is caused by significant force including a fall from a height, a car crash or a sports injury that twists the ankle. [25] However, other studies have found that patients who develop post-traumatic arthritis who first undergo open reduction internal fixation of their fractures with the intraoperative restoration of calcaneal morphology do better than those who develop subtalar arthritis due to malunion following non-operative treatment. Once the surgeon has committed to the minimal approach conversion to the extensile lateral approach is not recommended and thus great care must be taken in determining the correct approach for the correct patient. All surgical treatment is aimed at restoration of heel height and width (i.e., reconstructing the anatomy to reapproximateBohlerand Gissane angles), repair and realignment of the subtalar joint, and returning the mechanical axis of the hindfoot to functionality. Emergent reduction to relieve this tented skin is often recommended. -, Cottom JM, Douthett SM, McConnell KK. Some authors contend that anatomic reduction, fracture disimpaction, and repositioning is exceedingly difficult with limited exposures. In: StatPearls [Internet]. An official website of the United States government. Clinics in podiatric medicine and surgery. Techniques have been described to perform percutaneous calcaneal osteotomy and peroneal tendon decompression to try to alleviate subfibular impingement after calcaneal malunion. Sanders Classification: Based on reconstituted CT findings. 2019 Jun;40(6):634-640. Bethesda, MD 20894, Web Policies Write. The results of the analysis showed no statistically significant difference in post-operative calcaneal width, length, deep infection or Gissane's angle between the two approaches. In a linked paper (doi:10.1136/bmj.g4483), Griffin and colleagues report the results of a pragmatic, multicentre, randomised controlled trial comparing operative with non-operative care of closed, displaced intra-articular calcaneal fractures two years after injury.2 They excluded open injuries and grossly displaced fractures, where surgery is absolutely indicated. [1] Clinically Relevant Anatomy If a Calcaneus Fracture is demonstrated on the x-ray, you may be referred for a CT scan for further clarity on the size and location of the fracture. Before A conservative, non-invasive treatment regimen may also be recommended for patients who are not good candidates for surgery. Heel bone fractures are notoriously difficult to treat, and usually require prolonged healing times. He presented with constant pain, swelling of the foot and ankle and worsening pain with all ankle/foot movements. Calcaneus Fractures: FAQsCauses and Treatment for a Bruised HeelConditions that cause Heel Pain in the Morning, This is not medical advice. Surgical technique. Calcaneal body fractures with significant varus or valgus malalignment, lateral impingement, loss of calcaneal height, or significant translation of the posterior tuberosity. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal . Chronic pain is also a common complication, in many cases owing to post-traumatic subtalar arthritis, malalignment or stiffness resulting from the injury. . Their cohort of patients additionally had poor quality of life metrics post-operatively. Does internal fixation work? Test. 2003 Feb [PubMed PMID: 12571499], Eastwood DM,Langkamer VG,Atkins RM, Intra-articular fractures of the calcaneum. Consideration must also be given to imaging of other parts of the patient's body based on history given the high energy nature of the injuries that tend to cause calcaneal fractures. Wound complications and infections can be as high as 37% and 20% respectively with operative intervention. 1. Scenario: A 43-year-old man fell off of a ladder from approximately 7 ft high and landed completely on one foot. Certain Populations tend to have better results a well [27]: Due to the severe nature and the force required to sustain calcaneal fractures concomitant injuries must be considered. Some intraarticular injuries may be treated in a closed fashion depending upon severity. Overall the outlook for patients with calcaneus fractures is guarded. Calcaneus Fracture (Broken Heel) Treatment The calcaneus or heel bone is the largest bone in the foot and servers as the primary weight bearing structure in the heel. A calcaneus fracture is a heel bone fracture. [20]. Pathology Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: extra-articular: 25-30% anterior calcaneal process fracture 1993 Mar; [PubMed PMID: 8444935], Toussaint RJ,Lin D,Ehrlichman LK,Ellington JK,Strasser N,Kwon JY, Peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgery is no longer justified for most intra-articular displaced fractures, Displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. Immobilization with splinting, Bulky Jones type splints are commonly applied. [19], The goals of the minimally invasive technique (or sinus tarsi approach) are to minimize soft tissue injury while simultaneously allowing for fracture reduction and stabilization. [17]. Auto Accident. However, because of the lack of elevation of the L-flap, there is a decreased risk of peroneal tendon irritation and sural nerve complications. Calcaneal fractures occur on the calcaneus or heel bone, a large bone that forms the foundation of the rear part of the foot. This is not medical advice. 8600 Rockville Pike sharing sensitive information, make sure youre on a federal 2019 Feb; [PubMed PMID: 30448328], Buckley RE,Tough S, Displaced intra-articular calcaneal fractures. Loss of subtalar motion is very common as well. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intra-articular and displaced, affecting primarily the subtalar joint. This will usually occur five to ten days following the injury. A fall from a ladder or staircase can result in a calcaneus fracture, especially if you land on your heel sideways or firmly flat. Clin Podiatr Med Surg. Drains are typically removed on postoperative day 2 or even earlier based on surgeon preference. Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by calcaneus fracture. The Journal of bone and joint surgery. A heel bone fracture can be severe, painful and debilitating. The calcaneus is the bone that makes up your heel. [31]. Open fractures will most likely present with a laceration or puncture wound on the medial aspect of the foot. 2015 Feb [PubMed PMID: 24493866], Chu KM,Lui TH, Endoscopic Lateral Calcaneal Ostectomy and Peroneal Tendon Decompression With the Patient in the Prone Position as Management of Subfibular Impingement After Calcaneal Fracture. Critical Angle of Gissane/Gissane Angle. The tuberosity fragment may then rotate superiorly. Change every 2-3 hours to help with swelling. Loss of ipsilateral dorsalis pedis or posterior tibial pulse compared to contralateral limb should raise suspicion of arterial injury and prompt further investigation with angiography or Doppler scanning. Over penetration of the medial cortex of the constant fragment may lead to entrapment of the flexor hallucis longus tendon and fixed great toe flexion. Think of the calcaneus as an egg with in intact shell it is hard to break when you squeeze it in the palm of your hand, however, if there is any defect or crack in the surface, any abnormal pressure to the shell cause it to crumble as the center is soft and sponge-like. The results of this cohort ofverifiably well-reduced fractures demonstrated that the type III fractures were 4 times more likely to require eventual subtalar fusion compared to type II fractures. The sinus tarsi approach is performed by creating a 2-4cm incision along a line from the tip of the fibula towards the base of the fourth metatarsal base. There may be associated disability of the Achilles tendon, also raising the suspicion of a calcaneus injury. Tourniquet use is recommended for both approaches. Journal of orthopaedic trauma. Calcaneus fractures are rare but potentially debilitating injuries. Calcaneus Fracture. This occurs when a vertebra in the lower-mid back is crushed. [28][29] Studies have shown greater than 70% of patients with calcaneus fractures have additional injuries. The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. The Journal of the American Academy of Orthopaedic Surgeons. When this occurs, the heel can widen, shorten, and become deformed. The subtalar joint is formed by the calcaneus and the bone above it, which is called the talus. 2017 Sep-Dec [PubMed PMID: 28844198], Aldridge JM 3rd,Easley M,Nunley JA, Open calcaneal fractures: results of operative treatment. Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. Match. Fracture to the calcaneus is rare, with tarsal bones accounting for approximately 2% of all fractures, while Calcaneus Fractures account for 50-60% of those tarsal fractures. . Conservative treatment is most appropriate for simple, non-displaced fracture patterns, especially if they do not involve the joint. Historically a burst fracture of the calcaneus was coined a "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony to avoid detection. As severe as calcaneal fractures can be, studies have shown that non-surgical treatment can be very nearly as effective as surgical treatment in the right individuals. The calcaneus assumes a shortened and widened position with heel varus as a result of the fracture displacement and loss of Bohler's angle. The broken bone and swelling may cause you to feel throbbing where the bone is broken. Thus, the condition is best managed by an interprofessional team that includes a trauma surgeon, emergency department physician, orthopedic nurses, orthopedic surgeon, internist, and physiotherapist. The site is secure. [34]. This joint is important for normal foot function. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. Discrepancy between the normal angles of . The extensile lateral approach has been the primary approach for many years for operatively treating calcaneal fractures. Due to the force of the injury, the damage is often extensive and often requires surgery. Patients with a lighter workload (office work compared to heavy manual labor employment), Patients not receiving workers compensation. This occurs from a sudden movement and typically involves the Achilles Tendon or the Bifurcate Ligament. This study concluded with recommendations against operative intervention for closed, displaced, intra-articular fractures of the calcaneus. Please enable it to take advantage of the complete set of features! A small series was performed by Githens et al with the supposition that medial external fixator placement would allow for improved soft tissue healing, early restoration of calcaneal morphology, and reduction of wound-related complications by re-tensioning the incision during the operative intervention. Adams MR, Koury KL, Mistry JB, Braaksma W, Hwang JS, Firoozabadi R. Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures. The patient should be counseled of the expected sequela of surgical treatment and that, despite an adequate reduction, in more severe injuries subtalar osteoarthritis is extremely common. All open wounds need immediate surgery. Physical therapy exercises. Apply malleable freezer gel packs to the anterior ankle. Also, many patients will benefit from either custom or over the counter arch supports. Pathology Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: extra-articular: 25-30% anterior calcaneal process fracture Injury. Your doctor will examine your heel and foot, and get an x-ray to see if it is broken or not. A traumatic event will almost invariably precede the presentation of calcaneal injury. When conservative treatment is appropriate, a period of 4-6 weeks in a walker boot is recommended whereas walking short distances as pain allows is normally recommended. The calcaneus is the heel bone. Skin quality around the heel must be evaluated for tenting and/or threatened skin. Aggressive wound care and antibiotics as needed for contaminated wounds. Please let you doctor know if you are also experiencing any back pain. These injuries are also closely associated with the . Nondisplaced Sanders type I fractures may be treated in a conservative, closed fashion. [14](Level III), Complete recovery from a calcaneus fracture may take months or even years. The Journal of orthopaedic and sports physical therapy. Recent studies suggest regional variation in male/female predominance due to disparities in the types ofregional accident occurrence. official website and that any information you provide is encrypted Calcaneal tuberosity avulsion displaced sustentaculum tali, and large substantial calcaneal body fractures may require operative management. The connection between the talus and calcaneus forms the subtalar joint. Acta ortopedica mexicana. Injury. Fractures: Non-displaced or minimally displaced fragment, 2 bony fragments which are subdivided into A, B or C depending on if they are medial process or lateral process fracture, 3 bony fragments, divided into AB, AC or BC relative to the position and location of fracture lines. Calcaneus fracture commonly occurs during a high-energy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body. The calcaneus (also called the heel bone) is the largest tarsal bone of the foot. Help others by leaving a review of your experience. After 2 weeks, practice drawing a figure-8 with the toes to increase your range of motion in the ankle. X-ray imaging can be helpful in making a diagnosis. Compression. 2019 Feb 2; [PubMed PMID: 30739765], Ankle Radiograph Lateral Calcaneus Fracture. Most calcaneal fractures are occupational, and are caused by axial loading from a fall [ 2 ]. The worst results with regards to patient-reported outcomes and complications were found in the Grade III open fractures. 2014 Oct; [PubMed PMID: 25243849], Githens M,Shatsky J,Agel J,Bransford RJ,Benirschke SK, Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series. About 10% of patients with calcaneal fractures also suffer a back injury called a Lumbar spinal burst fracture. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Rearfoot fractures of either the heel bone (calcaneus) typically occur after a high impact/velocity injury, such as a fall from height or motor vehicle accident. A calcaneus fracture is a broken heel bone. When the calcaneus fractures, the hard outer layer can break into multiple irregular fragments and fold in on itself, just like an egg with a broken shell. BMJ (Clinical research ed.). Clinics in podiatric medicine and surgery. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. Historically a burst fracture of the calcaneus was coined a "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony to avoid detection. Journal of orthopaedic trauma. 2002 Oct [PubMed PMID: 12377902], Spierings KE,Min M,Nooijen LE,Swords MP,Schepers T, Managing the open calcaneal fracture: A systematic review. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. 2019 Apr;36(2):163-171. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. 2022 May-Jun;42(3):661-682. doi: 10.1148/rg.210167. Once you are allowed to bear weight on the foot, Dr. Perler usually sends you for physical therapy who will help you get back to full weight bearing and out of the boot over the following month. It is a rare type of fracture but has potentially debilitating results. [6][7]Similarly, a foot depressed against an accelerator, brake or floorboard translates a large amount of force through the calcaneus during high-speedautomobile accidents. Infections and wound breakdown are the most common and devastating complications of the extensile lateral approach. [33]. The provider must also keep in mind that certain fracture morphologies necessitate surgical care and that certain patient groups will do more poorly with surgery. Intra-articular calcaneal with subtalar joint depression. The epidemiology of tarsal fractures is as follows: Falls from a height directly translate energy into the calcaneus on impact as the heel strikes a surface crushing the calcaneus against the talus. Many times, surgery is necessary to restore normal anatomy and mobility. There are two types of calcaneus fractures: one involves the subtalar joint and one does not involve the joint. Outcomes with open calcaneal fractures are generally poorer than closed fractures. The varus deformity must also be corrected at this time. Alexander Orthopaedic AssociatesAdam D. Perler, DPM, FACFAS2438 Dr. ML King Jr. St. N. | Suite ASt. Non-weight bearing status for up to 10-12 weeks, Immobilization in a cast, fracture boot or splint for 8-10 weeks. Bibek Adhya, Himmat Dhillon, Sidak Dhillon, Mandeep Singh Dhillon. The amount of initial displacement based on Bohler's angle of <0 degrees is correlated with lower functional outcomes. Patients will present with diffuse pain, edema, and ecchymosis atthe affected fracture site. Long-term functional results in this cohort resulted in mild pain and some alterations in activities of daily living. Calcaneal stress fractures can cause intense pain and make walking more difficult. Low Vitamin-D levels, Osteopenia or Osteoporosis, can increase your risk of developing a Calcaneus Stress Fracture. This allocation was based on surgeon preference. The talus acting as a wedge causes depression and the widening of the calcaneal body. The results of the trial included a higher complication rate including infection and a requirement to remove hardware in 11% of the operative group, but there were no differences between the group with regards to health outcomes, range of motion, heel width, walking speed, and gait. Calcaneus Fracture Type I fractures: 1 nondisplaced or minimally displaced bony fragment. The three bones of the ankle include: The tibia, or shinbone The fibula, the smaller bone in the lower leg This activity reviews the causes, presentation, and diagnosis of calcaneus fractures and highlights the role of the interprofessional team in their management. Spell. Medicine. MeSH Journal of orthopaedic surgery (Hong Kong). [35][36](Level V), Adams MR,Koury KL,Mistry JB,Braaksma W,Hwang JS,Firoozabadi R, Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures. -, Hordyk PJ, Fuerbringer BA, Roukis TS. 2018 Mar 9; [PubMed PMID: 29523122], Sop JL,Sop A, Open Fracture Management . Journal of orthopaedic trauma. PLAY. Out of those fractures, 60 percent are classified as a calcaneus fracture. Depending on the cause of your injury, your foot and ankle specialist may also examine you for an ankle or mid-foot injury, or refer you to another specialist to check for injuries beyond the foot. A calcaneal stress fracture is a hairline crack or fracture in the heel bone (calcaneus). Avulsion fractures are when a tendon or a ligament pulls off a fragment of bone from the Calcaneus. Most patients with calcaneus fractures are young, with the 20-39 age group the most common. Immediately post-operatively the patient's foot and ankle should be placed into an extremely well-padded posterior splint. Foot [PubMed PMID: 30841752], Bibbo C,Siddiqui N,Fink J,Powers J,Ehrlich DA,Kovach SJ, Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical). The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. Treatment of these fractures may require surgery. A Shantz pin is still used through a percutaneous incision for manipulation of the calcaneal tuberosity. [20]. In: StatPearls [Internet]. Joint depression with articular comminution or anterior process involvement, Bohler's angle of <5 degrees on initial presentation, Anterior process fractures with >25% of the calcaneocuboid articulation involved. Clin Podiatr Med Surg. This type of fracture commonly occurs during a high-energy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body. Careers. Clin Podiatr Med Surg. A bstrAct. [22]. See what our patients have to say. Fracture to the calcaneus is also known as a Lovers Fracture as historically it occurs when landing from a fall, i.e. Furthermore, with significant height loss, calcaneal widening and hindfoot varus subfibular impingement may result from soft tissue or osseous abnormalities. The type of surgery required should be discussed with an orthopaedic consultant. Calcaneus Fracture. A recent randomized controlled trial reviewed operative versus non-operative treatment for closed, displaced, intra-articular calcaneus fractures. [8] Another study found that non-operative measures were up to 6 times more likely to lead to a late subtalar fusion due to symptomatic subtalar arthritis. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Fractures that don't involve the . Initial bony evaluation with AP, lateral, and oblique plain films of the foot and ankle is needed. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intra-articular and displaced, affecting primarily the subtalar joint. Bookshelf 2005 Dec;13(8):492-502. doi: 10.5435/00124635-200512000-00002. There are several types of fracture patterns that can occur with trauma to the heel bone. Calcaneal anatomy is demonstrated in Figure 1. A clinical assessment by a Physical Therapist can identify the likelihood of a Calcaneus Fracture through clinical tests such as the Calcaneal Squeeze test.If this test is positive for pain, it is likely that you will be referred for an x-ray.If a Calcaneus Fracture is demonstrated on the x-ray, you may be referred for a CT scan for further clarity on the size and . When the initial Bohler's angle is greater than fifteen degrees upon presentation their functional results will be better regardless of operative versus non-operative treatment. [16] Aldridge's group did recommend that definitive fixation not be performed at the time of initial irrigation and debridement. 1993 Jul; [PubMed PMID: 8519099], Shannon SF,Houdek MT,Wyles CC,Yuan BJ,Cross WW 3rd,Cass JR,Sems SA, Allgwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography. The peak incidence occurs in younger males [ 2 ]. [4][5]Falls from height and automobile accidents are the predominant mechanisms of injury, although jumping onto hard surfaces, blunt or penetrating trauma and twisting/shearing events may also cause injury. When this occurs, the heel can widen, shorten, and become deformed. Summarize the treatment options for calcaneus fractures including surgical options and the risks and benefits associated with treatment. The indication for this approach includes Sanders type II and III, patients with comorbidities that make soft tissue more vulnerable to complications include diabetes mellitus, smoking and/or obesity, peripheral vascular disease, and minimal posterior facet fragment comminution. The tibial artery and nerve run along the medial aspect of the calcaneal body and are thought to be shielded by the sustentaculum tali thus neurovascular injuries are uncommonwith calcaneal fractures. Open calcaneal fractures require emergent irrigation and debridement and careful wound management. American volume. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Previous literature by Siebert et al included 36 open calcaneal fractures in which there were 23 cases with complications including need for soft tissue coverage, nine cases of osteomyelitis, five amputations and one arthrodesis. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. Urgent fracture reduction should proceed at the first sign of skin compromise. The minimally invasive group's fracture composition was 61% Sanders II and 39% Sanders III. Often because of the great force needed to break the heel bone, other injuries to the knees and spine are common. 2. Avulsion fractures require a large amount of twisting or shearing force due to the strength of the ligamentous and tendinous attachments to the calcaneus. Accessibility If not treated emergently skin breakdown may lead to disastrous sequelae. Subdivided into types AB, AC, and BC, depending on the position and location of the fracture lines. This is especially important in the setting of Tongue-type calcaneus fractures. When this occurs, the heel can widen, shorten, and become deformed. Tongue type which has the same verticle fracture line as a depression type with another horizontal fracture line running posteriorly, creating a superior posterior fragment. The hindfoot articulates with the tibia and fibula creating the ankle joint. 2018 May-Jun; [PubMed PMID: 30521710], Diacon AL,Kimmel LA,Hau RC,Gabbe BJ,Edwards ER, Outcomes of midfoot and hindfoot fractures in multitrauma patients. Stress fractures may occur with overuse or repetitive use, such as running. The joint between the calcaneus and the talus is known as the subtalar joint, and it is an essential biomechanical component of flexing, standing, and walking and couples with the ankle joint for dynamic motion. Fracture patterns are similar in either mechanism. There was, however, a difference between wound complications, superficial infection, nerve injury, VAS pain scores, American Academy of Orthopedic Foot and Ankle Society (AOFAS) scores, calcaneal height and post-operative Bohler's angle in favor of minimally invasive techniques. Both groups had a 100% union rate and similar radiographic parameters with regards to Bohler's angle and the angle of Gissane. that allows for direct visualization of the posterior facet and the anterolateral fragment of the lateral wall. When this occurs, the heel can widen, shorten, and become deformed. 2016 Sep [PubMed PMID: 27603354], Gardner MJ,Nork SE,Barei DP,Kramer PA,Sangeorzan BJ,Benirschke SK, Secondary soft tissue compromise in tongue-type calcaneus fractures. Medicine. Those with an isolated fracture do recover with time but those with a concomitant injury to the pelvis, spine, neck or head often require prolonged rehabilitation and still have residual physical deficits. Peroneal tendon instability may result from displaced, intra-articular calcaneus fractures. Surgical management of calcaneal fractures. Clipboard, Search History, and several other advanced features are temporarily unavailable. Petersburg, Florida 33704PH: 727-547-4700 | FAX: 727-394-8661, Alexander Orthopaedic Associates Adam D. Perler, DPM, FACFAS12416 66th Street North | Suite ALargo, Florida 33773PH: 727-547-4700 | FAX: 727-394-8661. Unable to load your collection due to an error, Unable to load your delegates due to an error. Foot & ankle international. Calcaneal fractures account for 50-60% of allfractured tarsal bones. Many other groups have similar findings in that the sinus tarsi approach seems to lead to similar radiographic and functional outcomes with fewer wound complications overall. Access this article for 1 day for:30 / $37 / 33 (excludes VAT). [21]Of note, there was no comparison of pre-operative fracture morphology and many authors contend that more severe patterns require the extensile approach and are also predisposed to a higher complication rate. One hundred and eight calcaneus fractures operatively treated (Type II and III) were evaluated at a minimum of 10 years with an average follow-up time of 15.22 years. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. A. The decision to move forward with surgery must be based on fully informed consent of the abundant risks and expected benefits of surgery and must involve the patient in shared decision making as the operative intervention for calcaneal fractures is fraught with complications. An article by Aldridge et al in 2004 reviewed a case series of open calcaneal fractures and found that despite an increase in complications the quality of life metrics was higher than expected. When resting, prop your foot up on stools or pillows to keep it above your heart. Don't take our work for it! Clinical Management of Acute, Closed Displaced Intra-Articular Calcaneal Fractures. This part of the growing body of evidence that the smaller incision techniques may be useful in certain groups. We recommend a consultation with a medical professional such as James McCormack. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. A clinical assessment by a Physical Therapist can identify the likelihood of a Calcaneus Fracture through clinical tests such as the Calcaneal Squeeze test. You should follow the at-home treatments recommended for non-surgical patients, including rest, ice, elevation, and compression. 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). You should avoid bearing weight on the foot for 10-12 weeks until it is sufficiently healed. Epub 2022 Mar 11. Abnormalities of either of these findings should prompt a CT scan for further classification and evaluation of the fracture. -, Bibbo C, Siddiqui N, Fink J, Powers J, Ehrlich DA, Kovach SJ. A thorough evaluation of the entire spine should be performed anytime a calcaneal fracture is identified especially when a fall is a mechanism. These fractures often occur because of repetitive, long-term stress on the bone, such as from jogging. Type II fractures: 2 bony fragments involving the posterior facet. Journal of orthopaedic trauma. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. It is an overuse injury which was seen mostly in soldiers marching long distances carrying heavyweights. Calcaneus fractures usually hurt and get very swollen right after the injury. Tongue-type fractures can lead to variable amounts of displacement of the tuberosity fragment, but due to the pull of the Achilles tendon, significant superior and dorsal displacement may occur leading to the potential to tent the posterior heel skin and place the soft tissue at significant risk of breakdown. jumping out of a window or off a balcony. In this analysis, there were 2179 participants followed for an average of 22.41 months. Elevation of the foot. 2019 Feb; [PubMed PMID: 30664605], Shih JT,Kuo CL,Yeh TT,Shen HC,Pan RY,Wu CC, Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis. Calcaneus fractures have enormous morbidity and are often associated with many other injuries. Disclaimer, National Library of Medicine Rehabilitation Protocols for Calcaneus Fractures. Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical). Subdivided into types A, B, and C depending on the medial or lateral location of the fracture line. 2019 Apr; [PubMed PMID: 30784528], Schepers T, Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. Your doctor may prescribe you pain medication or you can take over-the-counter NSAIDs, such as Ibuprofen and Naproxen. This is often determined by serial x-rays performed in the office during your follow-up visits. The patient is not likelyable to bear weight. Foot Ankle Int. In: StatPearls [Internet]. Percutaneous fixation with Kirshner wires (K-wires) or screws may be implemented when soft tissue injury precludes an open approach. Joint depression type with a single verticle fracture line throughthe angle of Gissane separating the anterior and posterior portions of the calcaneus. Type III fractures:3 bony fragmentsincluding an additional depressed middle fragment. Describe the pathophysiology of calcaneus fractures. Pain medication. Patients with a higher initial Bohler's angle. The calcaneus connects with the talus and cuboid bones. We do not capture any email address. If you have recently experienced a trauma and are experiencing symptoms of a calcaneal fracture, visit your foot and ankle specialist. Many are treated with either open surgical reduction and internal fixation, percutaneous pinning, or sometimes arthrodesis. Weight-bearing is often delayed 8-12 weeks (or more depending on the degree of comminution and progression of healing on radiographs). The hindfoot articulates with the tibia and fibula creating the ankle joint. The .gov means its official. Gunshot wounds and other ballistic injuries cause a more diffuse nonpredictable fracture pattern but remain uncommon. The Journal of bone and joint surgery. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. Of note, this same incision may be used for subsequent subtalar arthrodesis should that be necessary. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. Some surgeons will favor primary subtalar arthrodesis as it seems to reduce the need for subsequent procedures and the associated increased costs and lost time from work associated with those additional surgeries. Clin Podiatr Med Surg. Copyright 2022 BMJ Publishing Group Ltd, North Petherton Surgery: GP Opportunity (up to 8 sessions) - North Petherton Surgery, Meadows Surgery: GP Opportunity (up to 8 sessions) - The Meadows Surgery, Ilminster, Bruton Surgery: GP Opportunity (8 sessions) - Bruton Surgery, Government of Jersey: Staff Grade in Trauma & Orthopaedics, Womens, childrens & adolescents health. 2014 Oct [PubMed PMID: 24983433], Radnay CS,Clare MP,Sanders RW, Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Process and tubercle fractures of the hindfoot. Clinics in podiatric medicine and surgery. 2014 Jul 24 [PubMed PMID: 25059747], Wei N,Yuwen P,Liu W,Zhu Y,Chang W,Feng C,Chen W, Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base. Flashcards. Splinting, ice and elevation will be helpful in improving tissue quality for later operative intervention. We recommend a consultation with a medical professional such as James McCormack. The lateral posterior facet joint surface must be anatomically reduced under direct visualization and may be held with temporary fixation, typically lag screw fixation will allow for compression and healing across the articular surface as described by Sanders et al [14]. Journal of orthopaedic trauma. Mondor's sign or ecchymosis of the foot extending distally onto the heel is a hallmark of this injury. Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. Upon removal of the boot, Physical therapy consisting of mobalisations, mobility and strengthening exercises should commence. Your foot and ankle specialist will assess your injury and determine whether to treat the fracture surgically or non-surgically. Up to a 40% displacement of the peroneal tendons has been appreciated on CT scans of calcaneus fractures. Type IV fractures: 4 comminuted bony fragments. Surgery is necessary for a lot of instances of a Calcaneus Fracture. Complete neurovascular examination as well as evaluation of all lower extremity tendon function. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. Anterior calcaneal process fractures are often missed fractures of the calcaneus (up to 88% are not reported on radiographic examination of the ankle) 1 leading to non-union of bone fragments, unrecognised associated ligamentous injuries, and persistent ankle or foot pain. Kline et al retrospectively reviewed a cohort of 112 calcaneal fractures in which 79 underwent the traditional extensile lateral approach and 33 were treated using minimally invasive techniques. Please note: your email address is provided to the journal, which may use this information for marketing purposes. Clinical orthopaedics and related research. [14]. The Journal of bone and joint surgery. 2019 Apr;36(2):323-337. Learn. These types of stress fractures are often misdiagnosed as Insertional Achilles Tendonitis. Stress fractures such as those seen in runners would be best evaluated with a bone scan or MRI. Non displaced fractures are managed conservatively. Most of the injuries cause the bone to flatten, widen, and shorten. This is usually related to the amount of force that was . Journal of orthopaedic trauma. He reported immediate pain in the foot with inability to bear weight. These high forces associated with landing from a height directly onto the Calcaneus are often sufficient to create an impact fracture. 2020 Jan [PubMed PMID: 28846249], Griffin D,Parsons N,Shaw E,Kulikov Y,Hutchinson C,Thorogood M,Lamb SE, Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. What do they look like - clinically? [13]. Fracture blisters may appear within 36 hours of injury. PMC The Calcaneus bone (heel bone) sits on the base of the foot under the ankle joint, one of several tarsal bones, and along with the talus, it forms the hindfoot. CT scan was performed immediately postoperatively and 95% of the fractures have posterior facet reduction to the anatomic position (with no appreciable step-off of the articular surface) and with no reductions >5mm inaccurately reduced. Sural nerve injury may result in up to 15% of cases treated operatively (more often with the extensile lateral approach). The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. The force from impacting the ground translates through the lower extremity and upward sometimes causing. 2017 Dec [PubMed PMID: 29245290], Sanders R,Vaupel ZM,Erdogan M,Downes K, Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. 2014 Feb 19 [PubMed PMID: 24553887], Ohashi K,Sanghvi T,El-Khoury GY,Ahn JM,Bennett DL,Geijer M,Inaoka T,Berbaum K, Diagnostic accuracy of 3D color volume-rendered CT images for peroneal tendon dislocation in patients with acute calcaneal fractures. Kline et al concluded that the minimally invasive technique was valuable and could lead to a lower complication rate and comparable results. The surgeon must then determine the appropriate approach and implants required to obtain that goal. Calcaneus (Heel Bone) Fractures A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. Initial care includes full neurovascular and musculoskeletal examination and patient history. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. Displaced Type III fractures have a higher likelihood of resulting in subtalar fusion than lower classification injuries and patients should be counseled that further procedures may be required, including possible subtalar fusion. Common complications may include: Following surgery, your foot and ankle specialist will likely immobilize your foot in a splint to allow the bone and joints time to heal. Calcaneal fractures present as a shortened-widened heel with varus deformity. Comorbidities such as diabetes and osteoporosis may increase the risk of all types of fractures. [8]Sanders et all describe that the soft tissue swelling may take up to 21 days to resolve and that surgery should not proceed until this has occurred. Calcaneal fractures most commonly occur during high energy events leading toaxial loading of the bone but can occur with anyinjury to the foot and ankle. and transmitted securely. BMC musculoskeletal disorders. American volume. In a head-on collision, it is common for the driver or a passenger to suffer from a broken heel upon impact. Treating a calcaneal fracture can be extremely tricky, because the fracture is rarely a clean break like you might see in a broken shin or arm. 4. Calcaneus fractures are a complex injury. The extensile lateral approach is performed by creating full-thickness soft tissue and periosteal flaps as previously described by Gould and lateral modified by Benirschke and Sangeorzan. 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