A calcaneal fracture is a broken heel bone. It’s one of the most serious foot injuries as the heel bone (calcaneus) is the largest bone in the foot and takes the full impact of every step. Most calcaneal fractures happen from a fall from height or a high-energy impact. Recovery is long, but with the right treatment, most patients return to normal activity in 6 to 12 months. This page explains what your options are, what surgery involves if it’s needed, and what recovery actually looks like.
How It Happens
The calcaneus is built to absorb shock, but it has limits. The most common cause is a fall from a height, landing on your feet from a ladder, roof, or vehicle. A rear-end car accident with the foot braced against the floor can also cause it. The bone essentially shatters under the sudden compression.
Stress fractures of the heel also occur from repetitive activity in runners and military recruits, though these are very different from the high-energy type and usually heal with rest.
What It Feels Like
Severe heel pain, immediate swelling that can spread up the ankle, and inability to put any weight on the foot are the hallmarks. The heel often looks wider than normal and may be bruised. In a high-energy fracture, you may also have injuries to the spine (compression fractures) or the opposite heel, landing on your feet from a fall loads both simultaneously.
Signs and Symptoms
Symptoms of a calcaneal fracture typically include:
- Pain in the heel and surrounding areas, especially when weight is placed on the foot.
- Swelling and bruising around the ankle and heel.
- Inability to bear weight on the affected foot.
- Heel deformity or visible changes in the foot’s shape, particularly in severe fractures.
- Difficulty with walking, standing, or performing other weight-bearing activities.
Diagnosis of Calcaneal fractures
Diagnosis of calcaneal fractures involves a combination of clinical examination and imaging studies:
- X-rays: Initial radiographs (AP, lateral, and oblique views) are typically used to confirm the fracture and assess its severity.
- CT scans: Given the complex nature of calcaneal fractures, CT scans are frequently used to assess the degree of articular involvement, fracture pattern, and alignment of bone fragments.
- MRI: Used to evaluate soft tissue damage, including ligament and tendon involvement, and to assess cartilage damage in the subtalar joint.
- Böhler’s Angle: A critical measurement on radiographs that is typically reduced in cases of calcaneal fracture.
Treatment Options
Non-Surgical Care
For non-displaced or minimally displaced fractures, non-surgical management is often sufficient:
- Rest and immobilization: Use of a splint or cast for 6–8 weeks to hold the bone in place while it heals.
- Pain management: NSAIDs or other pain medications to reduce inflammation and discomfort.
- Crutches or walker: To avoid weight-bearing on the affected foot.
- Physical therapy: To regain mobility and strength once the fracture heals sufficiently.
Surgical Care
Surgery is recommended for displaced fractures or those affecting the joint surface:
- Open Reduction and Internal Fixation (ORIF): Surgical procedure to reposition the bone fragments and stabilize them with plates and screws.
- Percutaneous Fixation: Minimally invasive technique for less severe fractures, where small incisions are made, and pins or screws are inserted to align the bone.
- Subtalar Arthrodesis: In cases of severe comminution or arthritis in the subtalar joint, fusion of the joint may be necessary.
Recovery and What to Expect After Treatment
- Non-surgical recovery: Healing typically takes 6–8 weeks, with gradual return to weight-bearing activities. Full recovery may take several months, with rehabilitation to restore strength and range of motion.
- Surgical recovery: Following surgery, recovery may take 3–6 months, with early mobilization and physical therapy to promote healing and prevent stiffness.
Possible Risks or Side Effects
- Wound healing issues: Particularly in open fractures or those with significant soft tissue damage.
- Infection: A risk with surgical treatment.
- Nerve damage: Possible injury to the sural or tibial nerves during surgery.
- Malunion or nonunion: Failure of the bone to heal properly may require additional surgery.
- Post-traumatic arthritis: A long-term risk, especially when the joint surface is involved.
Long-Term Outlook
Even with excellent treatment, calcaneal fractures can lead to some permanent changes. Post-traumatic arthritis in the subtalar joint is the most common long-term complication, occurring in a significant portion of patients with displaced fractures. This causes aching and stiffness with walking on uneven ground. In severe cases, a subtalar fusion (fusing the joint) can eliminate this pain effectively.
For insurance and cost information, see our Insurance Information page.Frequently Asked Questions (FAQ)
Frequently Asked Questions
Q. How long will I be on crutches? Typically 8 to 12 weeks, depending on whether surgery was performed and how the healing progresses. A knee scooter is a more comfortable alternative to crutches for many patients.
Q. Will I have arthritis afterward? There’s a real possibility, especially for severe, displaced fractures. About 1 in 3 patients develops some degree of subtalar arthritis over 10 years. Many manage it well with orthotics and activity modification. Some eventually need a fusion procedure.
Q. Can I get back to running? Many patients do, but it takes 12 to 18 months and a gradual return. Running on softer surfaces and limiting high-impact activity long-term is often necessary.
Summary and Takeaway
Calcaneal fractures, particularly those involving the posterior facet, pose significant challenges in orthopedic care. A detailed understanding of the anatomy, injury mechanism, and available treatment options is essential for successful management. While nonoperative management may be appropriate for less severe fractures, surgical intervention is often required for displaced or complex fractures. Advances in surgical techniques, including minimally invasive approaches, have improved outcomes and reduced complications.
When to Seek Emergency Care
A calcaneal fracture is an emergency. If you’ve fallen from height and have severe heel pain and can’t walk, go to the emergency department. Swelling can develop rapidly and become severe enough to affect wound healing if surgery is delayed too long. Report to an emergency department or call our office for guidance!
