Calcaneal (Heel) Fractures

Calcaneal fractures, typically caused by trauma or overuse, result in heel pain and swelling, with treatment options ranging from rest and immobilization to surgery, depending on the severity of the injury.

How Do Calcaneal Fractures Occur?

Most calcaneal fractures are the result of a traumatic event—most commonly, falling from a height, such as a ladder, or being in an automobile accident where the heel is crushed against the floorboard. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone.

Types of Calcaneal Fractures

Fractures of the calcaneus may or may not involve the subtalar and surrounding joints.



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). The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. 


Fractures that do not involve the joint (extra-articular fractures) include:

  • Those caused by trauma, such as avulsion fractures (in which a piece of bone is pulled off of the calcaneus by the Achilles tendon or a ligament) or crush injuries resulting in multiple fracture fragments
  • Stress fractures caused by overuse or mild injury
     

The severity and treatment of extra-articular fractures depend on their location and size.

Signs and Symptoms of Calcaneal Fractures

Calcaneal fractures produce different signs and symptoms, depending on whether they are traumatic or stress fractures. The signs and symptoms of traumatic fractures may include:

  • Sudden pain in the heel and inability to bear weight on that foot
  • Swelling in the heel area
  • Bruising of the heel and ankle
     

The signs and symptoms of stress fractures may include:

  • Generalized pain in the heel area that usually develops slowly (over several days to weeks)
  • Swelling in the heel area

Diagnosis of Calcaneal Fractures

To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle and order x-rays. In addition, advanced imaging tests are commonly required.

Treatment of Calcaneal Fractures

Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. The foot and ankle surgeon will discuss with the patient the best treatment—whether surgical or nonsurgical—for the fracture.



For some fractures, nonsurgical treatments may be used. These include:

  • Rest, ice, compression and elevation (RICE). Rest (staying off the injured foot) is needed to allow the fracture to heal. Ice reduces swelling and pain; apply a bag of ice covered with a thin towel to the affected area. Compression (wrapping the foot in an elastic bandage or wearing a compression stocking) and elevation (keeping the foot even with or slightly above the heart level) also reduce the swelling.
  • Immobilization. Sometimes the foot is placed in a cast or cast boot to keep the fractured bone from moving. Crutches may be needed to avoid weightbearing. For traumatic fractures, treatment often involves surgery to reconstruct the joint, or in severe cases, to fuse the joint. Dr. Levick will choose the best surgical approach for the patient.
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Levick Foot and Ankle Institute