What is the calcaneus?
The calcaneus (also known as calcaneum or os calcis) is the heel bone in the foot which articulates with the talus above to form the subtalar joint. The back of the calcaneum or tuberosity has the insertion of the Achilles tendon, the largest tendon in the human body which facilitates foot push-off during walking. The subtalar joint primarily contributes to the side-to-side movement of the hindfoot and allows the foot to accommodate to uneven surfaces when weight-bearing.
How does a calcaneal fracture usually present?
The majority of calcaneal fractures are intra-articular or involve the joint surface of the subtalar joint. The most common mechanism for this type of fracture is an axial load secondary to a fall from height or a motor vehicle accident. Patients with an acute fracture of their calcaneum classically present with a painful, swollen and bruised hindfoot, and an inability to weight-bear on their injured side.
What are the management options for a calcaneum fracture?
An intra-articular fracture of the calcaneus is often a significant injury obligated by a prolonged recovery period. For acute injuries, it is recommended that you limit your weight-bearing through your injured foot until you have sought medical advice. Non-operative treatment for a calcaneal fracture normally warrants offloading the injured foot in a CAM boot. The principles of surgical fixation include to restore the congruity of the articular surface of the subtalar joint and to reconstruct the shape (alignment, width and height) of the heel. The rationale for this is to try reduce the risk of post-traumatic arthritis (inflammation of a joint characterised by pain and stiffness) and to create a ‘shoe-able’ foot (or a normal-shaped foot that can fit into a normal shoe). Fixation of an intra-articular calcaneal fracture usually involves using a plate and screws with bone graft. Patients who develop symptomatic subtalar arthritis and who have failed non-operative management may eventually require a fusion of their subtalar joint.
What is the recovery after surgical fixation of my calcaneus fracture?
After surgical fixation of your calcaneum fracture, you will be non-weight-bearing through your operated foot for 6 weeks, and can then gradually progress from partial to full weight-bearing over another 6 weeks in a CAM boot. You will need to wear your CAM boot when ambulating only for up to 12 weeks, and will be instructed to do early ankle and foot range of motion and stretching exercises to reduce your stiffness. Once your surgical dressings have been removed after 2 weeks and your wounds are healed, you will also be encouraged to desensitise your surgical scars by massaging your wounds with a moisturising cream/oil, and to start exercising in the swimming pool or doing hydrotherapy. It can take 3-4 weeks for your wounds to heal, 5-6 months for your fracture to unite, 6-7 months before you are reasonably comfortable walking in cushioned sole normal supportive shoes, and up to 12-18 months for the swelling in your hindfoot to subside and for full recovery to your new baseline level.
What can I expect after a calcaneal fracture?
Unfortunately, patients who have sustained a significant intra-articular fracture of their calcaneus are likely to experience persistent stiffness and some pain in their hindfoot which is associated with swelling. They also typically have decreased standing and walking endurance, and describe difficulty ambulating on uneven ground. In the long term, these patients should be diligent with supportive footwear, maintain a healthy weight and preference low impact-loading activities for their vocation and exercise/recreation (such as swimming, cycling and Pilates)