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Intraarticular Calcaneal Fracture

An intraarticular calcaneal fracture is a fracture that appears in the heel of the foot. Generally, it is due to a high-impact injury, like a car accident or perhaps falling off a ladder. The severity of the fracture depends on the force of the impact at the time of injury. The fracture would be more critical if the injury were severe. Surgery is the leading treatment option in most cases, followed by physical therapy and a rigorous recovery process.

Structure

The bones of the feet are split into three lots: the forefoot, midfoot, and hindfoot. Seven bones make up the hindfoot and midfoot. The calcaneus (heel bone) is the largest. It is located at the back of the foot below the three bones that make up the ankle joint. These three bones are the:

1. 1. Tibia – (shinbone).
   2. Fibula – the smaller bone in the lower leg.
   3. Talus – the small foot bone that works as a hinge between the tibia and the fibula.

Collectively, the calcaneus, heel bone, and talus become the subtalar joint. The subtalar joint permits side-to-side movement of the hindfoot and is vital for balance on an uneven surface.

Description

An intraarticular fracture is a bone fracture where the break spans across the surface of a joint and always causes damage to the cartilage. A calcaneal (heel) fracture arises when the heel is compressed under the weight of one’s body, say from a car crash or falling off a ladder. The seriousness of an intraarticular calcaneal fracture can vary greatly. For instance, a twisted ankle might cause a single crack in the bone, while an injury that is more high impact, like a car accident, may cause the whole bone to shatter. The severity of a calcaneus injury can be affected by the following factors:

• How much damage is there to the cartilage surfaces in the subtalar joint.
• The number of fractures.
• The size of the broken bone fragments.
• How much damage is there to the surrounding soft tissues (muscle, tendons, and skin).
• The amount each piece of bone is displaced. In some situations, the broken ends of bones line up almost perfectly. There may be a large space between the broken bits; in more severe fractures, the fragments may be overlapped.

If a bone breaks and the bone fragments poke out of the skin, the fracture is described as an “open fracture”. Generally, an open fracture causes more damage to the surrounding tendons, muscles, and ligaments and is slower to heal. It is important to get immediate medical attention because open fractures have a higher risk of infection in the bone and the wound. The injured area will need to be cleaned to prevent infection.

Symptoms

The most common symptoms related to intraarticular calcaneal fractures include:

• Heel deformity
• Inability to put weight on the heel
• Pain
• Bruising
• Swelling
• Limping
• Instability that causes you to walk differently
• Inability to walk

Diagnosis

An Orthopaedic Associates of St. Augustine physician will review your symptoms and your overall health. If you have any other injuries or medical issues, such as diabetes or taking medications, make sure to inform your doctor. During the exam, your physician will:

• Examine your foot and ankle and ascertain if you have an open fracture.
• Determine if you can move your toes.
• Check your pulse to ensure that you have an adequate blood supply to the foot and toes.
• Confirm that you have sensitivity on the bottom of your foot.
• Establish whether you have injured any other areas of your body.

Your orthopedic physician may also order some tests to confirm that you have an intraarticular calcaneal fracture and not another medical condition. These tests may include:

• X-rays will generate images of bones. X-rays can indicate if the calcaneus is broken and if the bones are displaced.
• CT scans (Computed tomography) create a more detailed, cross-sectional image of the affected foot and provide the doctor with information about the severity of the fracture.

Treatment Overview

Non-surgical treatments are only recommended if the fractured bones have remained in place. If they have moved out of position, then surgery will be required to repair the bone properly. The healing progression can take from six weeks to three months and is contingent on the severity of the fracture.

Non-Surgical Treatment

Immobilization is the only non-surgical treatment available and involves wearing a cast, splint, or brace to keep the bones in your foot in the proper position for approximately six to eight weeks. To ensure a successful healing process, you cannot put any weight on the affected foot during this time.

Surgical Treatment

There are a number of surgical options available for intraarticular calcaneal fractures, including:

• Open Reduction and Internal Fixation. An incision is made to reposition the bones into their correct alignment. They are bound together with wires or metal plates and screws.
• Percutaneous Screw Fixation. If the broken bone pieces are large enough, they can be moved back into place without creating a large incision. Special screws are then placed into the heel through small incisions to keep the fracture together.

After the procedure, pain medications are often prescribed to manage the pain. There are many medications available to help control the pain, including non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil, Motrin, and aspirin, and local anesthetics. Your orthopedic physician may use a combination of these medications to improve your pain relief.

Next Steps

No matter if your treatment is surgical or nonsurgical, your rehabilitation activity will be very similar. Returning to daily activities will vary depending on the type and severity of the fracture and if you have other injuries.

Some patients can start weight-bearing activities a few weeks after surgery. Others may require waiting three months before putting weight on the heel. Most patients can begin partial weight-bearing between six and ten weeks after injury or surgery.

Frequently, doctors will encourage motion of the foot and ankle early during the recovery stage. Your physician may instruct you to begin moving the affected foot as soon as your pain permits. If you had surgery, you might be advised to wait until the wound has healed properly.

Your physician may also recommend physical therapy to help speed up the healing process. Certain exercises can assist in strengthening the supporting muscles and improve the range of motion in your foot and ankle. Even though exercises are often painful at the beginning and improvement may be difficult, exercises are necessary in order for you to resume normal activities.
You may need to utilize a walker, cane, crutches, or a special boot when you start walking again. If you put weight on your foot too early, the bone fragments or screws may shift out of place and cause more damage, resulting in another surgery.