heel fracture

Heel bone fracture: description

The heel bone fracture (Calcaneusfraktur) is one of the most common fractures of the tarsal bone with 60 percent. Men aged 25 to 45 are the most affected. A heel bone fracture often occurs in the context of workplace accidents.

The heel bone (calcaneus) is the largest bone of the foot and lies at the back of the heel. He assumes a central function for the arch of the foot. The shape of the heel bone is designed for high loads. The Achilles tendon attaches to the posterior end of the heel bone at the so-called Tuber calcanei. The bone is connected to the ankle bone (talus) via three articular surfaces and to the cube bone (cuboid), a tarsal bone, via another articular surface.

Heel bone fracture: symptoms

The typical symptoms are pain in the area of ​​the hindfoot and the heel. In addition, a noticeable pressure-painful swelling on the lateral hindfoot and on the sole of the foot can be seen. The hindfoot is usually shortened, making the contour of the heel plump. Due to the pain, the affected person can no longer burden the foot and does not properly move the lower ankle. In addition, concomitant injuries of the small foot muscles can occur.

In some cases there is an open heel bone fracture. Skin and soft tissue are damaged in such a way that, if necessary, bone fragments are visible from the outside. An open heel bone fracture must be promptly supplied emergency.

Heel bone fracture: causes and risk factors

The accident mechanism in calcaneal fracture (Calcaneusfraktur) is either a compression from above as in the fall from high altitude or a direct external force. When falling from a great height, usually both heel bones are broken – this applies to about ten percent of all cases. Multiple injuries often involve the spine or legs.

A heel bone fracture can also occur when the foot is pinched. This occurs, for example, in the context of an accident when the feet get under the pedals in the car footwell. Another possible cause of heel bone fracture is when the foot kinks.

Sometimes there is also a so-called fracture fracture (avulsion fracture) of the heel bone: If the calf muscle contracts strongly, the point of attachment of the tendon of the fibular muscle at the heel bone (Tuberositas calcanei) can tear. This break is frequently observed in people with osteoporosis.

Heel bone fracture: examinations and diagnosis

When a heel bone fracture is a specialist doctor for orthopedics and trauma surgery, the right contact person. To diagnose if the heel is broken, the doctor will ask you about the accident and your medical history and then examine you thoroughly. Some questions from the doctor might be:

• What does the exact accident happen?
• Did you hit your foot or did something fall on your foot?
• Do you have pain?
• Did you already have complaints like pain and restricted mobility?

The doctor will examine the foot closely and watch for soft tissue or other accompanying injuries. He also needs to examine if there is a compartment syndrome in which the tissue pressure is increased by swelling and blood so that nerves, muscles and vessels within a fascia are squeezed. If the tissue is permanently damaged, so-called claw toes can arise.

Imaging investigation

Subsequently, X-rays of the foot from the side and from the top and the upper ankle are made. Prior to surgery, a multi-layered computed tomography (CT) is usually used to plan the procedure accurately.

Heel bone fracture: treatment

The treatment of a heel bone fracture is always tailored to the individual patient. The goal of the treatment is to restore the adjacent articular surfaces and the structure of the hindfoot. Sometimes an operation is necessary, but it is technically difficult.

Heel bone fracture: conservative treatment

Unshifted fractions are usually treated conservatively. First, a plaster splint is applied to rest the foot. It can be partially loaded in the lower leg cast or relief shoe (Vacuped shoe) for about six to eight weeks. Afterwards, the foot can slowly be fully loaded again.

Heel bone fracture: surgical treatment

An operation is possible with a shifted heel bone fracture. The right time for the intervention plays a decisive role. For a fresh closed heel bone fracture, surgery should not be performed if the surrounding soft tissues are still swollen. With the so-called “wrinkle test”, the correct time of operation is determined: The procedure is only advisable if the skin on the affected region has already swollen so far that it can cause wrinkles. This is usually the case after six to eight days.

A heel bone fracture surgery is technically very challenging. If the bone has been impressed (impression fracture), this usually requires a so-called cancellous bone grafting: In this case, the body’s own bone material is introduced into the bone. The bone parts are held in position by means of screws or angle-stable plates.

After a fracture of the heel bone, you should have your individual shoes made by an orthopedic mechanic.

Heel bone fracture: Disease course and prognosis

The duration of healing and the outcome of the treatment depend on many factors: age, concomitant diseases, the physical strain at work and the type of break (postponed or not) play a role. As a general rule, curing a heel bone fracture is not that easy, because despite optimal treatment, there are often minor functional limitations. Especially debris fractures cause considerable difficulty with chronic pain when the foot is loaded.

Heel bone fracture: complications

If an heel bone fracture is operated, there is always the risk of a wound healing disorder: Up to 32 percent of patients have to struggle with it. Furthermore, surgery may damage the Nervus suralis, a sensory nerve of the lower leg. Another dreaded complication is compartment syndrome, which occurs in ten percent of cases. Last but not least, in some patients premature arthrosis in the joint is observed, caused by the cartilage damage associated with the heel fracture accompanied.