Calcaneus Fracture (Broken Heel Bone)

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Physical Therapy Videos - Foot & Ankle

What Is It?

The calcaneus, or heel bone, is a large bone under your ankle and at the back of your foot. It helps you walk and connects your calf muscles to your foot, which lets you push off when you step forward.

Skeleton model showing location of the calcaneus or heel bone in relation to the ankle joint and other bones
Figure 1: Skeleton model showing the calcaneus or heel bone in relation to the ankle joint and other bones of the foot.

 

X-Ray showing a normal calcaneus or heel bone
Figure 2: X-Ray showing a normal calcaneus or heel bone.

How It Happens

The calcaneus supports your body's weight, so it can get hurt if you fall from a ladder, roof, or have a car accident. The bone can break in different ways. If it breaks where the calf muscles connect, the broken pieces can move close to the skin, causing problems and maybe needing emergency surgery.

X-ray and CT images of a compression type fracture of the calcaneus with flattening and widening of the bone
Figure 3: X-ray (left) and CT images (right) of a compression (through the joint) type fracture of the calcaneus, with flattening and widening of the bone.

 

Fracture of the calcaneus due to the pull of the calf muscles with threatened skin at the back of the heel from the displaced bone fragment
Figure 4: Fracture of the calcaneus due to the pull of the calf muscles with threatened skin at the back of the heel from the displaced bone fragment.

First Steps

If you break your calcaneus, it usually hurts and swells right away. You might feel throbbing pain and see blisters. Your doctor will examine your foot and use x-rays or a CT scan to see the broken bone. They'll put your foot in a well-padded splint, boot, or partial cast to protect it. You should see a specialist or your regular doctor for follow-up care. Most people don't need to stay in the hospital, but sometimes urgent surgery is needed, and you may need to stay for that.

Treatment

Some broken heel bones need surgery, but others don't. The bone takes about three to four months to heal either way. If you don't need surgery, you'll still need to limit movement and weight on the foot. Surgery might be needed if the break is inside a joint or if the bone's shape has changed. Talk to an orthopaedic surgeon about your injury and the best treatment. If the bone broke through the skin or is close to doing so, you'll almost always need surgery.

Calcaneus fracture that has been treated without surgery and has healed in a position that makes the foot wide and short.
Figure 5: A calcaneus fracture that has been treated without surgery and has healed in a position that makes the foot "wide" and "short."

 

Compression type calcaneus fracture realigned and fixed with a plate and screws
Figure 6: A calcaneus fracture that has been realigned and fixed with a plate and screws.

 

Tension type calcaneus fracture realigned and fixed with screws
Figure 7: A calcaneus fracture that has been realigned and fixed with screws.

Recovery

While your heel bone heals, you won't be able to put weight on your foot. You might need physical therapy to help you move and put weight on the foot once it heals. It can take four to twelve weeks before you can put any weight on your foot, and even then, it might not be your full weight. Follow your surgeon's instructions for the best results.

Long Term

After a broken heel bone, you might have a limp or stiffness in your foot or ankle. Your heel could stay swollen compared to the other side. You might have pain when walking, especially on uneven ground. These problems usually get better over time, but your foot might always look or feel different. The joints in your injured foot can also get arthritis. If you had surgery, your surgeon will watch the wound to make sure it heals well. The metal plate and screws used to fix the bone are rarely noticed under the skin, but they might be removed later. In rare cases, if the bone doesn't heal or there's an infection, you might need more surgery. If you still have problems with your foot and heel after it heals, talk to your surgeon about whether more surgery could help.

Healed scars on the lateral part of the back of the foot from calcaneus fracture surgery
Figure 8: Examples of healed scars on the lateral (outside) part of the back of the foot from calcaneus fracture surgery.

 

Physical Therapy Videos - Foot & Ankle

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Matthew D. Riedel, MD
Edited by Christopher Domes, MD and David W. Sanders, MD
Unless otherwise credited, all images taken from the personal collections of Dr. Riedel and Dr. Domes