Heel Bone Fractures (Calcaneus Fractures): Overview

Heel Bone Fractures (Calcaneus Fractures): Overview

This video will provide an overview of breaks in the heel bone, also known as calcaneus fractures. We will review the anatomy, causes, signs and symptoms, and how a diagnosis is made.

The heel bone is the largest bone in the foot and is located in the back of the foot, also known as the hindfoot. It serves as a significant weight-bearing surface for the end of the leg. It forms connections with the talus and cuboid bones. Many soft-tissue structures attach to this bone, including the Achilles tendon, which connects to the back of the heel bone and plays a critical role in powering the calf muscles and moving the foot.

Fractures of the heel bone occur in various patterns. Understanding the type of fracture that has occurred will eventually lead to an understanding of the best treatment approach. The most common patterns of fracture in the heel bone extend into the nearby joint surfaces. Other patterns encountered include tongue-type fractures. Here, a fragment of the back of the calcaneus is displaced by the pull of the Achilles tendon. These fractures may cause serious soft-tissue damage because of the displaced fragment pressing into the tissue.

Another type is a crush injury in which the fracture is in multiple displaced pieces that extend into the key joints around the calcaneus. The bone may come through the skin in many of these fracture patterns. This is called an open fracture. Approximately 17% of heel bone fractures are open. While the overall incidence of these fractures is low, they occur nearly 2.5x more frequently in males than females, with the most common age of occurrence between 20 and 29 years old.

These fractures result from high-energy forces that compress the bottom of the foot. Approximately 70% are sustained after falling from a height. Car accidents may also contribute to these fractures. During an accident, significant force may be transferred to the foot from the pedals or floorboard. While these injuries are more likely to occur in isolation, they may be associated with other injuries.

While most calcaneus fractures are the result of high-energy trauma, 1 type of fracture may occur without such high force. This type of fracture is called a stress fracture. Stress fractures are typically smaller, hairline fractures. However, they can be found to be of varying severity. They may be seen with runners who repetitively stress the bone and are more common in women.

After a calcaneus fracture, a patient will have pain, swelling, and an inability to put weight on the foot. In severe swelling, blisters may be present. Patients should be alert for temperature or sensation changes in the foot. If these occur, along with intense pain, the health care team should be notified immediately as this may represent a more concerning complication of these fractures.

To diagnose a calcaneus fracture, a health care provider will examine the foot closely for damage to the soft tissue or abnormalities in sensation or blood flow. Multiple x-ray images will be ordered to confirm the fracture. A CAT scan will also better reveal the fracture pattern and help the health care team understand the extent of the injuries. Once the diagnosis has been made, the timing and type of treatment will be carefully determined and discussed with the patient.