Life After A Calcaneus Fracture

Calcaneal fractures are severe and debilitating injuries that occur from traumatic events, and have universally poor outcomes. Dr. Aron Green of the Seaview Orthopaedics Foot & Ankle Team was able to successfully repair the fractured heel bone of patient Robert R., get him back to his usual activities, and improve his quality of life post-fracture. Dr. Green is a board certified and fellowship trained orthopedic surgeon specializing in the foot & ankle care and surgery. Learn more about why calcaneal fractures are so difficult to treat and learn more about Robert’s story.

The calcaneus, or heel bone, is the largest of the seven tarsal bones in the foot. It is located at the back of foot below the ankle.

The calcaneus can be thought of as an eggshell that shatters when subjected to significant force.  These fractures tend to occur with falls from a significant height or motor vehicle accidents.

One of the issues with these fractures is that the entire dorsal or top surface of the bone has a complex and undulating articulating joint surface that allows the foot and ankle to go side to side and accommodate for uneven terrain.  If this joint surface is disrupted, there will be limitations in motion, which will affect function. Additionally, if the joint is more than 1 or 2 millimeters out of position substantial posttraumatic arthritis can develop which will lead to lifelong pain and loss of function.

Calcaneal fractures are devastating injuries that tend to affect young and healthy individuals. This injury is one that is limb threatening and lifestyle altering.

The articular surface of the calcaneus is divided into 3 facets that articulate with the talus.  It is well known that any fracture through an articular surface can lead to fissuring of the articular cartilage/joint surface and cause a release of toxic enzymes that will kill healthy joint cells.  This will lead to the development of arthritis and pain.

Calcaneal fractures are classified according to the Sanders classification 1-4 with 4 being the most severe.  Some scientific articles have gone so far as to call for primary joint fusion for a type four fracture due to the dismal outcomes with open reduction and internal fixation of the fracture.  Some studies have also called for benign neglect of these fractures due to poor outcomes in certain patient populations.

Traditionally calcaneal fractures were treated in an open fashion with large incisions, frequent wound healing, and infectious complications.  Recently minimally invasive techniques have emerged that seem to decrease wound healing and infections but are much more challenging to obtain an accurate reduction of the fracture.

Our patient sustained a very bad type 4 fracture that was treated with a minimally invasive approach.  Most patients with this injury have almost complete loss of motion which our patient retained (see video); and he is currently able to play golf and ride a motorcycle which most patients with these injuries are unable to do.  To be able to pivot and turn and walk on uneven surfaces of a golf course are unimaginable for most patients that have suffered a calcaneal fracture as is the ability to support the weight of a Harley.

Book an appointment with orthopedic Foot & Ankle surgeon Dr. Aron Green today.