Calcaneus Fracture

Anatomy and Function of the Calcaneus

The calcaneus, or heel bone, is the largest bone in the foot, playing a crucial role in distributing body weight during walking, daily activities, and sports activities. Located beneath the astragalus or talus, it forms the hindfoot and contributes to the formation of the plantar arch. A fracture of this bone can therefore significantly disrupt the mechanics of the foot and ankle due to always present cartilage damage, and the risk of progressing to a pseudo flatfoot valgus with post-traumatic osteoarthritis of the subtalar joint.

Causes and risk factors of calcaneus fracture

The main causes of calcaneus fracture include:

1. Severe trauma: Falls from a great height, car or motorcycle accidents. In case of a fall from a great height with a calcaneus fracture, you should always look for an associated lumbar spine fracture, which occurs in 20% of cases.
2. High-risk sports: Activities such as climbing or contact sports can increase the risk of falling or collision.
3. Osteoporosis: Reduced bone density can make bones more susceptible to fractures even with minor trauma. The calcaneus can present with stress fractures or insufficiency fractures.

Symptoms and diagnosis

The symptoms of a calcaneus fracture are :

• intense pain in the heel with initially impossible weight-bearing.
• swelling and bruising around the heel.
• a visible deformity of the heel, which becomes very thick with tense skin.

The diagnosis is based on a clinical examination followed by medical imaging tests. An X-ray allows visualization of the extent of the fracture, assessment of the bone structure, depression of the joint surfaces, lateral cortical blowout, and the articular congruence of the subtalar joint.

A CT scan of the ankle is systematically performed because it allows for clarification of the fracture, identification of the different fracture lines, bone structure, bone density, and also helps plan a surgical procedure if necessary and guides bone reconstruction procedures.

Treatment

Conservative treatment

In cases of stable and non-displaced fractures, non-surgical treatment may be considered. This includes :

• Immobilization of the ankle using a walking boot or a cast.
• Rest and elevation of the foot to reduce the always-present swelling.
• Painkillers and anti-inflammatory medications to relieve pain.

Surgical treatment

For displaced or complex fractures, surgery is often essential. The commonly used surgical techniques are :

• Open reduction of the fracture with internal fixation : This procedure involves an incision to reposition the bone fragments and fix them with plates and screws.
• Arthroscopic reduction of the fracture with percutaneous osteosynthesis.
• External fixation : Used in some cases, this method involves stabilizing the bone with an external device attached by pins passing through the skin and bone.

Rehabilitation

Post-fracture rehabilitation is crucial to regain optimal functionality. It includes:

• Physiotherapy: Specific exercises to strengthen the foot and improve the joint mobility of the subtalar region.
• Progressive rehabilitation: Gradual resumption of weight-bearing on the affected foot, often supervised by a physiotherapist.
• Regular follow-up: Follow-up consultations to monitor skin, tissue, and bone healing, and adjust the treatment plan if necessary.

Prevention

To prevent calcaneal fractures, it is recommended to:

• use appropriate protective equipment during high-risk activities.
• maintain good physical condition and strengthen the lower body muscles.
• take measures to prevent falls, especially in elderly people or those with osteoporosis.