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Indiana Podiatry Group
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How The Heel Bone Can Become Fractured, and What Is Done To Treat It

Fractures of the heel bone, also called the calcaneus, occur most commonly due to a fall from a height greater than three feet. These fractures can be potentially very debilitating, and require prompt medical attention. Due to the significant injury required to break this bone, about one quarter of these injures have other fractures of the foot or leg associated with them, and one tenth of them have an associated spinal fracture.

The heel bone is a generally strong, thick bone located at the heel, naturally. It interacts with a bone above that itself forms the foot part of the ankle joint (talus), and at its end towards the middle of the foot the heel bone interacts with a stout bone called the cuboid. These points of interactions are joints, and unfortunately heel bone fractures often disrupt the joints, particularly where the heel bone meets the talus. For this reason, heel bone fractures can have long term disabling effects if they are not properly treated, including arthritis and chronic pain.

Heel bone fractures are generally very painful, and can have significant bruising and swelling around the heel. The injured heel can appear wider than the non-injured heel, and blisters can form on the skin a short while after the fracture has occurred. One typically cannot walk on a heel that has been fractured, unlike a bruise where one can generally bear some weight on the heel.

The heel bone has several different places it can fracture in, each with different treatment requirements. The heel bone can fracture along the bottom, particularly if the heel strikes the ground forcefully while being positioned slightly inward and outward. Typically this fracture's treatment only requires external repositioning and immobilization in a cast. Other locations the heel bone can fracture in involves a shelf of bone sticking out along the inner side, as well as the top part of the end of the bone when it meets the middle of the foot. Either of these locations can potentially involve a joint, and if the fracture fragment has moved out of place surgery may be needed to bring them back into proper position. Otherwise external repositioning and casting is used for treatment. Yet another fracture pattern involves the back half of the bone, usually as a result of the Achilles tendon and its associated muscles forcefully contracting upward on the bone, shearing the back half away at and angle. This fracture does not involve a joint, and can typically be externally repositioned and treated with a cast that has the ankle bent somewhat downward to keep the Achilles tendon from pulling the fracture piece upward. If the bone cannot be properly positioned, surgery is needed to place the bone correctly and restore proper function to the Achilles tendon. One final fracture type involves the main body of the heel bone, and can be the most disabling. The majority of these fractures disrupt a joint, and has the potential for significant complications if not properly treated. In this fracture, the heel bone is fractured in multiple places, and the wall of the heel bone can 'blow out', leading to a widening of the heel. While some of these fractures can simply be treated with a cast, many need surgery with the use of multiple screws and bone plates to stabilize the fracture and allow the heel bone to heal in a proper position without joint displacement.

Long term complications from heel fractures include arthritis as mentioned above, ankle and associated tendon pinching, displacement of the fat pad of the heel, and widening of the heel itself. Further surgery is sometimes needed in cases that develop debilitating arthritis, as joint fusion may be needed to eliminate pain. Other treatment that may be required include long term ankle bracing, physical therapy, and special inserts to stabilize the bottom of the heel.