A reader recently sent me the following question when discussing calcaneus fractures and treatment.
“Dr. Silverman, I had calcaneus fracture 5 months ago and my heel is somewhat deformed. In your opinion, how long should I wait to do the reconstruction operation or arthrodesis?”
With so much pressure exerted on our heels on a daily basis, it’s easy to see how a calcaneal fracture can inhibit your gait, and that imbalance can prevent the injury from healing perfectly. Simply put, an unreconstructed calcaneus is in a tilted inward position that creates abnormal weight bearing to the outside of the heel and foot. Non-surgically treated calcaneus fractures can develop many problems, including:
- Your heel can widen, making it difficult to fit in shoes.
- Improper healing can cause peroneal tendon dislocation.
- Development of a fibular abutment (a situation where the heel bone pushes against fibula).
- The joint can develop arthrofibrosis, otherwise known as a stiffening of the joint.
- Arthritis can set in.
That said, plenty of people can fully recover from a calcaneal fracture without surgery so long as they stick to their doctor and physical therapist’s recommendations and no abnormalities cause the foot to heal incorrectly.
Reconstructing the Calcaneus
Reconstruction is challenging and the operation has three main goals.
1. Solid arthrodesis (fusion) to treat the arthritis.
2. Narrow the heel to reduce the peroneal tendon and make shoewear fit better.
3. Heel height and alignment: The most difficult goal to obtain as it involves recutting the fracture and/or spreading the joint apart with a distraction arthrodesis.
The choice to do the fusion surgery after a calcaneus fracture requires a fair amount of planning and a lot of intra-operative work. Non-surgical management includes bracing, injections, and weight-bearing monitoring. Generally, people with calcaneal fractures that still hurt after six months and are showing no signs of improvement are candidates for surgery. As the reader said, his heel is still somewhat deformed. If pain or discomfort is present, a visit with a foot specialist or surgical consultation could provide more answers.
