The calcaneus is the bone in the back of the foot, commonly referred to as the heel bone. This bone helps support the foot and is important in normal walking motions. The joint on top of the calcaneus is responsible for allowing the foot to rotate inwards and outwards
Calcaneus fractures are almost always the result of high-energy injuries. They usually occur as a result of a fall from a height, such as falling from a ladder. Other causes of a calcaneus fracture include automobile accidents and sports injuries.
The calcaneus can also sustain a stress fracture, an injury sometimes seen in athletes, such as long-distance runners. Stress fractures are a different type of injury from a traumatic fracture.
The fracture may be of one of the following types:
-An undisplaced fracture resulting from a minimal violence.
-An extra-articular fracture,where the articular surfaces remain intact,and the force splits the calcaneal tuberosity vertically.
-An intra-articular fracture,where the articular surface of the calcaneum fails to withstand the stress.
Swelling and broadening of the heel.
Ecchymosis around the heel and on the sole
It is possible to diagnose most calcaneum fractures on a lateral X-ray of the heel.
In some cases,an additional axial view of the calcaneum may be required
Very often,rather than a clear fracture extending through the calcaneum,there occurs crushing of the bone.This can be diagnosed on a lateral X-ray of the heel by reduction in the tuber-joint angle.
Nonoperative treatment of calcaneus fractures requires the cooperation of a multidisciplinary team involving an orthotist, a physical therapist, an occupational therapist, and a surgeon familiar with the pattern of injury involved.
Most extra-articular calcaneus fractures are managed nonoperatively, provided that the injury does not change the weight-bearing surface of the foot and provided that it does not alter hindfoot biomechanics. Severely comminuted intra-articular fractures may be managed nonoperatively, particularly when reconstruction is likely to be unsuccessful.
Closed reduction may be attempted by plantarly displacing both the forefoot and the hindfoot to reverse the mechanism of injury, which allows for elevation of the posterior facet. However, this approach rarely results in a durable maintenance of the reduction.
Many authors recommend short leg casting and no weight bearing for 2 weeks, followed by range-of-motion exercises. Progressive weight bearing should begin at 8 weeks, with full weight bearing by 12 weeks.
Multiple surgical approaches are available for treatment of calcaneus fractures, ranging from minimally invasive percutaneous fixation to extensive open techniques. Open techniques may be performed by using medial, lateral, or combined approaches, depending on the extent of injury and the location of the fracture fragments.
ORIF of a calcaneus fracture is made difficult by the complex anatomy, the presence of soft cancellous bone (which is not amenable to screw fixation), and the high incidence of postoperative wound infection and breakdown.
Most reports suggest that the functional outcome is related to the accuracy of the subtalar joint reduction, the restoration of normal heel morphology, the status regarding subfibular decompression, and the implementation of postoperative measures to decrease swelling.
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