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Heel Bone Fracture

What is a Heel Bone Fracture?

Heel bone fractures are rare, but potentially debilitating injury. The heel bone (Calcaneum) is located at the back of the foot and generally takes the initial impact when walking. It is the largest bone in the foot.  

What Causes a Heel Bone Fracture?

Calcaneal fractures most commonly occur from high impact or accidents, which cause over loading of the bone. However, it can occur from any injury to the foot and ankle. Falls from height and automobile accidents are the main causes of Heel Bone Fractures, but they can also be caused by jumping onto hard surfaces, blunt trauma or intense twisting motions.  

Heel Bone Fractures, including stress fractures, may also occur with overuse or repetitive movements, such as running. It could be brought on by change of shoes, running surface, frequency of exercises or unfamiliar activity. Pain usually starts gradually, and then becomes so intense it prevents any further impact sport.

How is a Heel Bone Fracture Diagnosed?

Depending on the severity of the fracture, different scans may be recommended in addition to a full neurovascular and lower extremity examination. Bruising and swelling around the heel, and subsequently, the foot, are integral to the clinical presentation. X rays are the initial investigation of choice.  A CT scan may be requested as it gives a better picture of the broken parts and their orientation. If a stress fracture is suspected, an MRI scan will likely be needed.

What are the Treatment Options?

The severity of the Heel Bone Fracture will determine the initial treatment recommendations. 

Open fractures often require urgent surgical treatment and aggressive wound care. Urgent / emergency cases would be sent to A&E.

For closed fractures (no open wounds), pain medication, icing and elevation with be recommended with appropriate immobilization using a splint. All surgical treatment is aimed at restoring the heel height and width, repair and realignment of the hindfoot joints, and returning the mechanical axis of the hindfoot to functionality. The leg is then immobilised in a plaster cast for 2 weeks. No weight is allowed on the limb for 2 weeks. When the wound heals and the stitches have been removed in 2 weeks, patient can bear weight in an AIRCAST boot. Rehabilitation is started early and has been shown to be associated with early back to work and full recovery.

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