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. The Journal of bone and joint surgery. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. Surgical technique. A fall from a ladder or staircase can result in a calcaneus fracture, especially if you land on your heel sideways or firmly flat. 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. These fractures often occur because of repetitive, long-term stress on the bone, such as from jogging. A temporizing measure is typically to place a removable posterior splint in plantarflexion with close skin monitoring until definitive treatment. A recent randomized controlled trial reviewed operative versus non-operative treatment for closed, displaced, intra-articular calcaneus fractures. 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. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. This activity reviews the causes, presentation, and diagnosis of calcaneus fractures and highlights the role of the interprofessional team in their management. Subdivided into types AB, AC, and BC, depending on the position and location of the fracture lines. About 10% of patients with calcaneal fractures also suffer a back injury called a Lumbar spinal burst fracture. [13]. [20]. 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. If you are unable to import citations, please contact A traumatic event will almost invariably precede the presentation of calcaneal injury. Calcaneus fractures are rare but potentially debilitating injuries. 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. This will usually occur five to ten days following the injury. This occurs from a sudden movement and typically involves the Achilles Tendon or the Bifurcate Ligament. Before Immediately post-operatively the patient's foot and ankle should be placed into an extremely well-padded posterior splint. Created by. 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. Does internal fixation work? Treatment of these fractures may require surgery. 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. Help others by leaving a review of your experience. This part of the growing body of evidence that the smaller incision techniques may be useful in certain groups. A thorough evaluation of the entire spine should be performed anytime a calcaneal fracture is identified especially when a fall is a mechanism. [1][2][3]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. . 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. A conservative, non-invasive treatment regimen may also be recommended for patients who are not good candidates for surgery. 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. Calcaneus Fracture 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. Typically, non-surgical treatment involves: Surgical correction of a fractured heel bone is a risky procedure. 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. 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. The Journal of orthopaedic and sports physical therapy. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. Foot & ankle international. Clinics in podiatric medicine and surgery. He offers Online Physiotherapy Appointments for 45. The talus acting as a wedge causes depression and the widening of the calcaneal body. Clin Podiatr Med Surg. 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. [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. Don't take our work for it! The broken bone and swelling may cause you to feel throbbing where the bone is broken. 2005 Dec;13(8):492-502. doi: 10.5435/00124635-200512000-00002. An official website of the United States government. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. 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. [16] Aldridge's group did recommend that definitive fixation not be performed at the time of initial irrigation and debridement. Peroneal tendon instability may result from displaced, intra-articular calcaneus fractures. You may see blisters form. Journal of orthopaedic surgery (Hong Kong). 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. Acta ortopedica mexicana. 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 fracture of the calcaneus, or heel bone, can be a painful and disabling injury. The peak incidence occurs in younger males [ 2 ]. [22]. 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. Overall, they screened 2006 patients with calcaneal fractures, of whom a quarter (n=502) were eligible . The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. He presented with constant pain, swelling of the foot and ankle and worsening pain with all ankle/foot movements. Out of those fractures, 60 percent are classified as a calcaneus fracture. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. 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. Please let you doctor know if you are also experiencing any back pain. Calcaneal tuberosity avulsion displaced sustentaculum tali, and large substantial calcaneal body fractures may require operative management. Calcaneus fractures usually hurt and get very swollen right after the injury. Kline et al concluded that the minimally invasive technique was valuable and could lead to a lower complication rate and comparable results. Calcaneus (Heel Bone) Fractures A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. [30]This is considered post-traumatic arthritis. 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. Treatment for Calcaneus Fracture is decided based on the type and location of the fracture. Type III fractures:3 bony fragmentsincluding an additional depressed middle fragment. FOIA Restoration of normal alignment and contour is considered the . When resting, prop your foot up on stools or pillows to keep it above your heart. Type IV fractures: 4 comminuted bony fragments. Icing. Patients with a lighter workload (office work compared to heavy manual labor employment), Patients not receiving workers compensation. Clinics in podiatric medicine and surgery. Skin quality around the heel must be evaluated for tenting and/or threatened skin. and transmitted securely. 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. Process and tubercle fractures of the hindfoot. 2019 Apr;36(2):163-171. Recent studies suggest regional variation in male/female predominance due to disparities in the types ofregional accident occurrence. 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. 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. 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. This joint is important for normal foot function. Many times, surgery is necessary to restore normal anatomy and mobility. Calcaneus fractures have enormous morbidity and are often associated with many other injuries. Tourniquet use is recommended for both approaches. 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. Their cohort of patients additionally had poor quality of life metrics post-operatively. The https:// ensures that you are connecting to the 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]. . 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. Joint depression type with a single verticle fracture line throughthe angle of Gissane separating the anterior and posterior portions of the calcaneus. 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. Auto Accident. Although screws are thought to provide greater stability . In patients with identifiedthreatened soft tissueupon presentation treated with emergent operative reduction and fixation none went on to further soft-tissue complications[24]. official website and that any information you provide is encrypted Normal = 25 -40 degrees; posterior facet/calcaneal tuberosity fx decreases this angle If remains above 15 degrees nonoperative treatment is an option. This is not medical advice. The force from impacting the ground translates through the lower extremity and upward sometimes causing. Journal of orthopaedic trauma. 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. PMC [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. In: StatPearls [Internet]. A fracture from a fall may require simple strengthening and rehabilitation while a Calcaneus Stress Fracture from running can require a thorough gait analysis and running re-training alongside insoles and changes in footwear. Non-weight bearing status for up to 10-12 weeks, Immobilization in a cast, fracture boot or splint for 8-10 weeks. 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. 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. 2019 Apr;36(2):323-337. 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 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. Nondisplaced Sanders type I fractures may be treated in a conservative, closed fashion. [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. Most calcaneal fractures are occupational, and are caused by axial loading from a fall [ 2 ]. MeSH Furthermore, all serous and hemorrhagic blisters must be epithelialized. 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. All open wounds need immediate surgery. 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. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. This allocation was based on surgeon preference. Calcaneus fractures are rare but potentially debilitating injuries. Severe heel bone fractures can extend into the ankle joint and fracture the cartilage that . [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. 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. The most common cause of a Calcaneus Fracture is a fall from a balcony, ladder, table or window. Acta radiologica (Stockholm, Sweden : 1987). Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. 2014 Oct [PubMed PMID: 24983433], Radnay CS,Clare MP,Sanders RW, Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? 2019 Apr;36(2):269-277. 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). 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. When this occurs, the heel can widen, shorten, and become deformed. Clinical orthopaedics and related research. 1. Drains are typically removed on postoperative day 2 or even earlier based on surgeon preference. Open calcaneal fractures require emergent irrigation and debridement and careful wound management. Your doctor may prescribe you pain medication or you can take over-the-counter NSAIDs, such as Ibuprofen and Naproxen. Displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. [14]. There are several types of fracture patterns that can occur with trauma to the heel bone. 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. 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. A clinical assessment by a Physical Therapist can identify the likelihood of a Calcaneus Fracture through clinical tests such as the Calcaneal Squeeze test. In: StatPearls [Internet]. Calcaneal anatomy is demonstrated in Figure 1. 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. -. BMJ (Clinical research ed.). 2017 Feb [PubMed PMID: 28129268], Hsu AR,Anderson RB,Cohen BE, Advances in Surgical Management of Intra-articular Calcaneus Fractures. Please enable it to take advantage of the complete set of features! Open fractures will most likely present with a laceration or puncture wound on the medial aspect of the foot. Calcaneus fractures are a complex injury. A calcaneal fracture occurs when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle). X-ray imaging can be helpful in making a diagnosis. Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. 2008 Mar;29(3):318-24. doi: 10.3113/FAI.2008.0318. Calcaneal fractures present as a shortened-widened heel with varus deformity. Clinics in podiatric medicine and surgery. 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. Medicine. Fracture patterns are similar in either mechanism. Journal of orthopaedic trauma. -, Hordyk PJ, Fuerbringer BA, Roukis TS. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. Calcaneus Fracture. You can download a PDF version for your personal record. Most calcaneal fractures are occupational, and are caused by axial loading from a fall [ 2 ]. It is a rare type of fracture but has potentially debilitating results. Often because of the great force needed to break the heel bone, other injuries to the knees and spine are common. Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical). A calcaneus fracture is a heel bone fracture. Flashcards. Evaluation of a potential calcaneus fracture should include the following: Calcaneal fractures can be classified into two general categories.[9][10]. 2004 Jan; [PubMed PMID: 14676550], Siebert CH,Hansen M,Wolter D, Follow-up evaluation of open intra-articular fractures of the calcaneus. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Apply malleable freezer gel packs to the anterior ankle. 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. Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. 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. Scenario: A 43-year-old man fell off of a ladder from approximately 7 ft high and landed completely on one foot. When this occurs, the heel can widen, shorten, and become deformed. The Journal of the American Academy of Orthopaedic Surgeons. Falls. Subfibular impingement may result in lateral heel pain, particularly with eversion of the hindfoot. 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. The site is secure. 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. The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. 2022 Aug 8. 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. A patient may notice swelling and heat around their heel bone, and there may be subtle bruising on the heel bone. The extensile group's fracture composition was 53% Sanders II and 47% Sanders III. Summarize the treatment options for calcaneus fractures including surgical options and the risks and benefits associated with treatment. 2017 Sep-Dec [PubMed PMID: 28844198], Aldridge JM 3rd,Easley M,Nunley JA, Open calcaneal fractures: results of operative treatment. However, they are also seen in long-distance runners, ballet dancers and sports involving jumping. Clinical orthopaedics and related research. Correct diagnosis and workup must include orthogonal X-Rays, specialized views, and a CT scan is considered the gold standard for a complete diagnosis. Most patients with calcaneus fractures are young, with the 20-39 age group the most common. Stress fractures such as those seen in runners would be best evaluated with a bone scan or MRI. Adams MR, Koury KL, Mistry JB, Braaksma W, Hwang JS, Firoozabadi R. Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures. The extensile lateral approach has been the primary approach for many years for operatively treating calcaneal fractures. Fractures that don't involve the . Physical therapy exercises. Surgical treatment tends to fall into one of two categories, the open extensile lateral approach, and minimally invasive techniques. . 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. Wound complications and infections can be as high as 37% and 20% respectively with operative intervention. 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. 2022 May 29. Copyright 2022, StatPearls Publishing LLC. Routine serial radiographs should be obtained to ensure the progression of healing. The worst results with regards to patient-reported outcomes and complications were found in the Grade III open fractures. 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. Infections and wound breakdown are the most common and devastating complications of the extensile lateral approach. The three bones of the ankle include: The tibia, or shinbone The fibula, the smaller bone in the lower leg However, a recent meta-analysis was performing comparing minimally invasive techniques with the standard lateral extensile approach. HHS Vulnerability Disclosure, Help A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. 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. Clinics in podiatric medicine and surgery. 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. The hindfoot articulates with the tibia and fibula creating the ankle joint. Techniques have been described to perform percutaneous calcaneal osteotomy and peroneal tendon decompression to try to alleviate subfibular impingement after calcaneal malunion. 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. Disclaimer, National Library of Medicine J Am Acad Orthop Surg. Overall the outlook for patients with calcaneus fractures is guarded. Up to a 40% displacement of the peroneal tendons has been appreciated on CT scans of calcaneus fractures. 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. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 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. [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. See what our patients have to say. It is part of the hindfoot and sits directly below the three bones that make up the ankle joint. The calcaneus (also called the heel bone) is the largest tarsal bone of the foot. 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. Spell. Traditionally, there is a male predominance of injuries due to the industrial nature of the accidents. Calcaneal fractures are rare in children. 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. The subtalar joint is formed by the calcaneus and the bone above it, which is called the talus. 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. Surgical treatment must be delayed until the so-called, "wrinkle sign," returns. Both groups had a 100% union rate and similar radiographic parameters with regards to Bohler's angle and the angle of Gissane. [14](Level III), Complete recovery from a calcaneus fracture may take months or even years. This occurs when a vertebra in the lower-mid back is crushed. Review the evaluation of a patient with a calcaneus fracture. This is often determined by serial x-rays performed in the office during your follow-up visits. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. 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. Bookshelf An extraarticular fracture accounts for 25% of all Calcaneus Fractures, while intraarticular fractures account for 75%. 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 Describe the pathophysiology of calcaneus fractures. -, Bibbo C, Siddiqui N, Fink J, Powers J, Ehrlich DA, Kovach SJ. What do they look like - clinically? sharing sensitive information, make sure youre on a federal Medicine. 2019 Feb 2; [PubMed PMID: 30739765], Ankle Radiograph Lateral Calcaneus Fracture. A temporary reduction may be maintained by the placement of Kirschner wires through this tuberosity fragment into the "constant" fragment of the medial sustentaculum. 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. He reported immediate pain in the foot with inability to bear weight. All patients who are candidates for outpatient treatment are non-weight bearing at discharge. 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. Fracture to the calcaneus is also known as a Lovers Fracture as historically it occurs when landing from a fall, i.e. After 2 weeks, practice drawing a figure-8 with the toes to increase your range of motion in the ankle. 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. 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. Initial bony evaluation with AP, lateral, and oblique plain films of the foot and ankle is needed. [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. The hindfoot articulates with the tibia and fibula creating the ankle joint. If you have recently experienced a trauma and are experiencing symptoms of a calcaneal fracture, visit your foot and ankle specialist. A. The Journal of bone and joint surgery. [31]. [28][29] Studies have shown greater than 70% of patients with calcaneus fractures have additional injuries. A heel bone fracture can be severe, painful and debilitating. Splinting, ice and elevation will be helpful in improving tissue quality for later operative intervention. Subtalar osteoarthritis may result from surgical or nonsurgical treatment with an increasing number of patients with non-operatively treated displaced intra-articular calcaneus fractures requiring late subtalar fusion as a result of subtalar arthritis. Emergent reduction to relieve this tented skin is often recommended. Long-term functional results in this cohort resulted in mild pain and some alterations in activities of daily living. The patient is not likelyable to bear weight. It allows for adequate visualization intra-operatively and allows for manipulation of the fracture to restore alignment and articular surfaces. [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. 2019 Jun;40(6):634-640. [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. 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. STUDY. Your foot and ankle specialist will assess your injury and determine whether to treat the fracture surgically or non-surgically. This is especially important in the setting of Tongue-type calcaneus fractures. Upon removal of the boot, Physical therapy consisting of mobalisations, mobility and strengthening exercises should commence. The group demographics were comparable. Conservative treatment is most appropriate for simple, non-displaced fracture patterns, especially if they do not involve the joint. You doctor will evaluate your foot for swelling and other signs of a fracture or joint damage. Calcaneus fractures are a severe and life-changing injury. Complete neurovascular examination as well as evaluation of all lower extremity tendon function. 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. Change every 2-3 hours to help with swelling. Surgery is necessary for a lot of instances of a Calcaneus Fracture. Patients with a higher initial Bohler's angle. Test. You should avoid bearing weight on the foot for 10-12 weeks until it is sufficiently healed. 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. 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. 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. Journal of orthopaedic trauma. The connection between the talus and calcaneus forms the subtalar joint. Avulsion fractures require a large amount of twisting or shearing force due to the strength of the ligamentous and tendinous attachments to the calcaneus. 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. 2019 Apr; [PubMed PMID: 30784536], Hordyk PJ,Fuerbringer BA,Roukis TS, Clinical Management of Acute, Closed Displaced Intra-Articular Calcaneal Fractures. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Would you like email updates of new search results? Alexander Orthopaedic AssociatesAdam D. Perler, DPM, FACFAS2438 Dr. ML King Jr. St. N. | Suite ASt. 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. Most of the injuries cause the bone to flatten, widen, and shorten. You should follow the at-home treatments recommended for non-surgical patients, including rest, ice, elevation, and compression. Calcaneus Fracture. Radiographics. Critical Angle of Gissane/Gissane Angle. A general pain in the heel that gradually worsens could be a sign of a stress fracture. 2002 Oct [PubMed PMID: 12377902], Spierings KE,Min M,Nooijen LE,Swords MP,Schepers T, Managing the open calcaneal fracture: A systematic review. Also, many patients will benefit from either custom or over the counter arch supports. In this analysis, there were 2179 participants followed for an average of 22.41 months. 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. 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. Heel bones are often injured in a collision where other skeletal parts sustain injury as well. Learn. American volume. 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. The Journal of the American Academy of Orthopaedic Surgeons. Abnormalities of either of these findings should prompt a CT scan for further classification and evaluation of the fracture. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. 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 calcaneus is the heel bone. 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. 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. Write. Access this article for 1 day for:30 / $37 / 33 (excludes VAT). British volume. 2019 Apr; [PubMed PMID: 30784540], Cottom JM,Douthett SM,McConnell KK, Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. [26], The Sanders classification has been found to have sustained prognostic value. Sanders Classification: Based on reconstituted CT findings. Patients will present with diffuse pain, edema, and ecchymosis atthe affected fracture site. Clipboard, Search History, and several other advanced features are temporarily unavailable. Repetitive stress on the Calcaneus bone from activities such as running can cause a Calcaneus Stress Fracture. [15]. Arthroscopy techniques. Plantar ecchymosis extending through the plantar arch of the foot should raise suspicion significantly. Calcaneal body fractures with significant varus or valgus malalignment, lateral impingement, loss of calcaneal height, or significant translation of the posterior tuberosity. Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. When this occurs, the heel can widen, shorten, and become deformed. 4. The tuberosity fragment may then rotate superiorly. jumping out of a window or off a balcony. The type of surgery required should be discussed with an orthopaedic consultant. The calcaneus assumes a shortened and widened position with heel varus as a result of the fracture displacement and loss of Bohler's angle. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. Outcomes with open calcaneal fractures are generally poorer than closed fractures. Avulsion fractures are when a tendon or a ligament pulls off a fragment of bone from the Calcaneus. Stress fractures may occur with overuse or repetitive use, such as running. 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 Sural nerve injury may result in up to 15% of cases treated operatively (more often with the extensile lateral approach). A bstrAct. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. If you have a subscription to The BMJ, log in: Subscribe and get access to all BMJ articles, and much more. This will typically on hurt during activity and gets better with rest. Mondor's sign or ecchymosis of the foot extending distally onto the heel is a hallmark of this injury. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal . 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. Tarsal fractures account for 2% of all fractures. BMC musculoskeletal disorders. Clin Podiatr Med Surg. 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. [14], Surgical intervention is typically recommended for the following indications:[15]. government site. Surgical management of calcaneal fractures. However, because of the lack of elevation of the L-flap, there is a decreased risk of peroneal tendon irritation and sural nerve complications. 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. The varus deformity must also be corrected at this time. 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. 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. Many are treated with either open surgical reduction and internal fixation, percutaneous pinning, or sometimes arthrodesis. that allows for direct visualization of the posterior facet and the anterolateral fragment of the lateral wall. Foot Ankle Int. 2018 Mar 9; [PubMed PMID: 29523122], Sop JL,Sop A, Open Fracture Management . Calcaneal stress fractures can cause intense pain and make walking more difficult. The peak incidence occurs in younger males [ 2 ]. Normal Bohlers and Gissane angles do not rule out a fracture. 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. Calcaneal fractures account for 50-60% of allfractured tarsal bones. Feel free to get in touch with us and send a message. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. After surgery complications are common and may include compartment syndrome, osteomyelitis, wound infection malunion and subtalar arthritis. Journal of orthopaedic trauma. 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. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. This is usually related to the amount of force that was . Gravity. 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. 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. Type II fractures: 2 bony fragments involving the posterior facet. 1998; [PubMed PMID: 9801778], Benirschke SK,Sangeorzan BJ, Extensive intraarticular fractures of the foot. These injuries are also closely associated with the development of post-traumatic arthritis of the subtalar joint (rearfoot). 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. Calcaneus fractures are rare but potentially debilitating injuries. There are two main classification systems of extraarticular fractures. These types of stress fractures are often misdiagnosed as Insertional Achilles Tendonitis. 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. Those with an isolated fracture do recover with time but those with a concomitant injury . Epub 2022 Mar 11. Rehabilitation Protocols for Calcaneus Fractures. This study concluded with recommendations against operative intervention for closed, displaced, intra-articular fractures of the calcaneus. The amount of initial displacement based on Bohler's angle of <0 degrees is correlated with lower functional outcomes. [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. 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. Federal government websites often end in .gov or .mil. Please note that narcotics in our practice are extremely restricted and are NOT a good long term solution. 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. The calcaneus is the most fractured of all tarsal bones. 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. The minimally invasive group's fracture composition was 61% Sanders II and 39% Sanders III. The Journal of bone and joint surgery. The risk is reduced with a more inferiorly based L-incision. Clin Podiatr Med Surg. Due to the force of the injury, the damage is often extensive and often requires surgery. This site needs JavaScript to work properly. Chronic pain is also a common complication, in many cases owing to post-traumatic subtalar arthritis, malalignment or stiffness resulting from the injury. Type I fractures: 1 nondisplaced or minimally displaced bony fragment. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. The calcaneus is the bone that makes up your heel. Unable to load your collection due to an error, Unable to load your delegates due to an error. PLAY. The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. Foot Ankle Int. When surgical management is recommended it is with the goal to restore calcaneal morphology and to restore articular congruency. [34]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Injury. Heel bone fractures are notoriously difficult to treat, and usually require prolonged healing times. Similar types of Calcaneus Fractures can occur due to car crashes. 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. [17]. Calcaneal fractures occur on the calcaneus or heel bone, a large bone that forms the foundation of the rear part of the foot. [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. Calcaneal anatomy is demonstrated in Figure 1. The calcaneus connects with the talus and cuboid bones. Of note, this same incision may be used for subsequent subtalar arthrodesis should that be necessary. Elevation of the foot. A Shantz pin is still used through a percutaneous incision for manipulation of the calcaneal tuberosity. Typically a small, low-profile is plate is used after reduction of the joint surface and is placed along the joint-line. There may be associated disability of the Achilles tendon, also raising the suspicion of a calcaneus injury. 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. Immobilization with splinting, Bulky Jones type splints are commonly applied. 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. 2. The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. Some authors contend that anatomic reduction, fracture disimpaction, and repositioning is exceedingly difficult with limited exposures. 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. Combined ipsilateral fractures of talus and calcaneus. 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. We recommend a consultation with a medical professional such as James McCormack. Match. [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. Pain medication. 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. The wound complication rate was 29% in the extensile lateral group with 9% of the total treated cases requiring repeat surgery for those complications. 2018 Nov 5; [PubMed PMID: 30467055], Zhang Z,Wang Z,Zhang Y,Qiu X,Chen Y, Risk factors for increased postoperative drainage of calcaneal fractures after open reduction and internal fixation: An observational study. Physical Therapy can last for 4-6 weeks depending on the cause of injury. The .gov means its official. It included a total of 151 patients with 73 in the operative arm and 78 in the non-operative arm. 2019 Apr;36(2):211-224. 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. Overall the outlook for patients with calcaneus fractures is guarded. Journal of orthopaedic trauma. Bethesda, MD 20894, Web Policies Loss of subtalar motion is very common as well. 8600 Rockville Pike Journal of orthopaedic trauma. The surgeon must then determine the appropriate approach and implants required to obtain that goal. 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. Discrepancy between the normal angles of . 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. Urgent fracture reduction should proceed at the first sign of skin compromise. Injury. 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 Journal of bone and joint surgery. 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. Calcaneus Fracture Diagnosis. Compression. The hindfoot articulates with the tibia and fibula creating the ankle joint. These high forces associated with landing from a height directly onto the Calcaneus are often sufficient to create an impact fracture. 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). 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. Only 6% of the minimally invasive group had wound complications and none required additional surgery. The hindfoot articulates with the tibia and fibula creating the ankle joint. 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. We do our best to listen to our patients. 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. Calcaneus fractures are rare but potentially debilitating injuries. 2022 May-Jun;42(3):661-682. doi: 10.1148/rg.210167. A calcaneus fracture is a broken heel bone. 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. American volume. American volume. A calcaneal stress fracture is a hairline crack or fracture in the heel bone (calcaneus). jsandoe. Archives of orthopaedic and trauma surgery. [33]. Some intraarticular injuries may be treated in a closed fashion depending upon severity. 2004 May-Jun; [PubMed PMID: 15161170], Jimnez-Almonte JH,King JD,Luo TD,Aneja A,Moghadamian E, Classifications in Brief: Sanders Classification of Intraarticular Fractures of the Calcaneus. 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 . The closure is typically recommended with an interrupted Allgwer-Donati stitch to try to relieve tension on the incision itself. 2019 Feb; [PubMed PMID: 30448328], Buckley RE,Tough S, Displaced 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. [20]. Initial care includes full neurovascular and musculoskeletal examination and patient history. Calcaneus Fractures: FAQsCauses and Treatment for a Bruised HeelConditions that cause Heel Pain in the Morning, This is not medical advice. Gunshot wounds and other ballistic injuries cause a more diffuse nonpredictable fracture pattern but remain uncommon. Tarsal fractures account for roughly 2 percent of all fractures in adults. 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. 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. We do not capture any email address. Care must be taken to ensure one does not over-penetrate the medial cortex. Intra-articular calcaneal with subtalar joint depression. Here are some of the causes of a calcaneus fracture. [1] Clinically Relevant Anatomy technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. There are two main categories of Calcaneus Fracture. 2019 Apr; [PubMed PMID: 30784528], Schepers T, Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. Percutaneous fixation with Kirshner wires (K-wires) or screws may be implemented when soft tissue injury precludes an open approach. Careers. [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. Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by calcaneus fracture. 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. In a head-on collision, it is common for the driver or a passenger to suffer from a broken heel upon impact. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. Pain in the heel, with diffuse tenderness on palpation of the heel Swelling Plantar ecchymosis Adjunctive percutaneous screws are often placed to assist with the other parameters of calcaneal morphology including height, width and hindfoot alignment. 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. [14]. Clin Podiatr Med Surg. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. 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