Causes, symptoms and treatment options for a calcaneal fracture. Heel bone fracture - how long does it take to heal, how long does it take? Orthosis for a calcaneal bone fracture reviews

An injury such as a fracture of the calcaneus is rare and mainly affects young people, athletes and people with joint diseases such as osteoporosis or arthrosis. Due to the inability to step on the entire foot, a person’s mobility is impaired, and therefore, he loses his ability to work for a certain period of time. There are several types of injuries, which include a fracture of the calcaneus with displacement, without displacement, open or closed injury. Also, the patient is always concerned about the question of when the calcaneal fracture occurred, how long it will heal and how it is treated.

The heel bone is considered a strong structural element, since it bears a lot of stress throughout life, so it will not be so easy to break it. As already mentioned, young people suffer more and this is due to their activity. To get fractures of the heel bones, you need to fall from a height onto your feet, and this is the most common cause of injury. As is known, older people are less mobile and rarely undergo such injuries; a fracture can occur in them with concomitant pathologies of the musculoskeletal system. Treatment for a fracture of the calcaneus is always long-term; rehabilitation after a fracture of the calcaneus plays an important role, since during immobilization muscle atrophy occurs and the person literally has to learn to step on the foot again.

Classification

The classification of heel bone fractures depends on the cause that caused it, the volume of lesions and is divided into several types. First of all, a fracture of the calcaneus occurs without displacement and with displacement; the treatment option and the clinical picture of the disease depend on this. When displacement occurs, a bone fragment can damage blood vessels, nerves, and soft tissues, which can cause the patient to face complications such as bleeding and neuralgia.

Depending on the anatomical damage, injuries in the lateral process, medial process, damage to the body and tubercle are divided. Ligaments, muscles, tendons may be involved in the pathological process - sprains and tears may occur, which also affects the manifestation of the pain syndrome. Often, when falling from a height, a comminuted fracture is recorded, when open reduction is used for treatment to restore the patient’s mobility of the leg.

A compression fracture of the calcaneus is considered dangerous; it occurs when falling from a height onto your feet, when the heel is compressed, thereby injuring the talus, and the ankle joint can be damaged. Often this injury is accompanied by displacement and may require surgery to treat. Among the complications of such an injury, one can highlight the threat of injury to the spine and metatarsal bones, since at the moment of a fall strong vibration is transmitted to the body. You can break the heel of one leg or both, which also affects the treatment option and the future rehabilitation period.

Causes and symptoms

Like many other fractures, trauma to the heel bone is associated with three main reasons:

falling from a height onto your feet is a common cause;
compression of the leg during an accident, pinching by a heavy object or its fall on the heel area;
age-related injury due to osteoporosis and due to hereditary diseases of the osteoarticular system.

Most often, heel damage occurs due to jumping from a height, and the higher the height, the more dangerous consequences. It is a displaced fracture of both heel bones that occurs when falling from a height and is considered a dangerous condition, the treatment of which takes more than one month. Athletes and army recruits are often affected by such injuries.

In second place according to statistics are road traffic accidents, since in a head-on collision the body of the car is deformed and excessive pressure is placed on the legs. Often, heel damage occurs at work when a heavy object falls on the feet, pinching the foot and squeezing it.

Symptoms of a calcaneal fracture depend on the strength of the traumatic factor, the presence of displacement, fragments and the presence of damage to the person’s skin. So, with an open fracture, a wound is formed that bleeds and if help is not provided in time, the person may be at risk of infection. If a comminuted fracture is recorded, severe pain occurs due to damage to the nerve endings.

The main sign of injury is pain, its nature depends on the degree of damage. In addition to pain, the patient experiences soft tissue swelling, which gradually increases. With a closed fracture, a hematoma may develop. Movement of the foot is limited due to severe pain. If the patient experiences an injury without bone displacement or a marginal fracture, there may be no swelling or hematoma, and the symptoms of pain will not be as severe. In any case, the patient will not be able to step on the heel due to increased pain.

Diagnosis and treatment

The fracture must be treated after diagnostics to determine the extent of the damage. To do this, the doctor conducts an examination and prescribes x-ray diagnostics. If possible, then a computed tomography can be performed for an accurate diagnosis, because a person’s future performance depends on the diagnosis and treatment.

To treat fractures, the immobilization method is always used, that is, immobilization of the foot and ankle to allow bone healing. Immobilization is used both during conservative treatment and after surgery. For the purpose of immobilization during conservative treatment, plaster casting is used.

In case of a simple fracture, without any displacement, the fragments are cast in a cast starting from the fingers and ending with the knee joint or part of the ankle. Before applying the plaster, the doctor models the arch of the foot to avoid complications after removing the plaster. By the way, the main complications after heel fractures are pathologies such as valgus deformity and the development of flat feet.

For fractures of the calcaneus, bed rest is prescribed for the first few days, and only after that the patient can move, relying on a crutch. Do not step on the injured leg. The period of immobilization directly depends on the extent of the injury, but rarely the plaster is removed before 1.5 months, the average period of immobilization is two, two and a half months. Some medical centers use polymer material instead of plaster casts to immobilize the leg.

Complicated fractures with displacement and the presence of fragments are treated surgically. An osteosynthesis procedure is prescribed, during which the bone fragments are fixed, for which a plate is inserted. Bone reduction of fragments can also be used.

Rehabilitation

After the plaster cast is removed, the post-fracture rehabilitation phase begins. The patient needs to learn to step on the affected heel, but he may feel discomfort and pain. A popular method of rehabilitation is the use of orthoses. An unloading orthosis for a fracture of the calcaneus can reduce the load and swelling in the leg. The orthosis is considered a preventive method against the development of muscle atrophy; it also makes it easier to step on the injured leg.

Exercise therapy helps to recover. Physical education should be gentle at first, because it can cause slight pain. Positive effect gives a therapeutic massage, which can be started during the period of immobilization, massaging the upper part of the leg, fingers, this technique prevents muscle atrophy. Leeches and physiotherapy procedures are often used for rehabilitation.

Gymnastics should be carried out for at least 2-3 months to avoid the formation of flat feet, arthrosis, and deformation of the fingers. The main techniques of exercise therapy are bending and straightening the legs at the knees, stimulating the toes with the same movements. You can start these techniques while your leg is in plaster. When the plaster is removed, exercises on a massage mat, using massage balls that need to be rolled out on a hard surface, help a lot.

It is worth remembering that the result of treatment depends not only on the doctor and the casting method, but also on the rehabilitation stage, when the mobility of the leg is restored. In the future, physical labor should be combined with rest so as not to overwork the injured leg.

Prevention of heel fractures is based on compliance with safety precautions. There is no need to jump from a height, you need to try to drive the car carefully and follow safety precautions at work. If an injury does occur, then the main goal before the ambulance arrives is to create rest for the leg in order to avoid complications such as displacement of fragments and further fracture of the bone. You can reduce the manifestation of pain by applying cold; for severe pain, analgesics are given.

The heel bone in the arch of the foot breaks quite rarely, especially on both sides. The main cause of a fracture is often a strong blow to the heels or a fall on the feet from a height. Often such an injury is combined with a fracture in the thoracic and lumbar regions spine or ankle joint.

After completion of the recommended treatment, a long period of rehabilitation is required. An orthosis for a fracture of the calcaneus can significantly facilitate and speed up the recovery process.

Mechanism and causes of fracture

The heel bone is rightfully considered the largest bone of the foot. When walking and standing, it bears most of the load and acts as a shock absorber. According to anatomical data, it is customary to distinguish the body and the tubercle located behind it. In front, the bone has a connection with the cuboid bone, and above with the talus.

It is the talus bone that directly connects the heel and shin bones to each other. In the event of a jump to the feet or a high-altitude fall, the weight of the entire body is transferred to the ankle, and through it to the talus. The result is its wedging into the heel bone, followed by splitting the latter into pieces.

The fracture and its type, the nature of the displacement of fragments directly depend on the position of the foot and the height of the fall. Another cause of fractures can be bone compression due to an accident or physical exercise of a permanent nature among professional athletes. A fracture due to a blow to the heel bone with a massive object is much less common.

Classification

All calcaneal fractures are usually divided into two large groups:

extra-articular fractures: tubercles (horizontal, vertical, separation of the median tubercle, “beak” type), body;
intra-articular: compression, isolated, marginal, with and without displacement of fragments.

We should not forget that a fracture often leads to damage to surrounding tissues. Based on this feature, fractures are classified into closed and open.

Symptoms

The main complaint for a fracture in the heel area is pain. During the examination, pronounced swelling is noticeable, extending all the way to the Achilles tendon. Other symptoms include:

change in the shape of the foot in the heel area (expands and flattens);
presence of hemorrhage (occupies the center of the sole);
pain on palpation;
preservation of movements in the ankle joint (if it is not broken).

A characteristic sign is the fact that the patient cannot stand on his foot.

Important! Calcaneal fractures often go undetected due to concomitant spinal or ankle injuries. In this regard, all patients whose injury is associated with a fall on the foot should be examined for the presence of this fracture.

Diagnosis and treatment

To diagnose a heel fracture, in addition to collecting complaints and the presence of injury, an external examination and additional research methods are important. Radiography in three projections is of key importance. The nature of the damage is judged by the change in the angle of the heel bone (Behler angle).

For a non-displaced fracture, conservative therapy is indicated by immobilizing the affected limb with a plaster cast. It is applied for a period of at least three weeks from the toes to knee joint. If there is displacement, the treatment tactics change - reposition is performed under local anesthesia.

Particular attention is required to comminuted fractures that accompany damage to the articular surfaces of the talus and calcaneus and significant displacement of bone fragments. If necessary, an Ilizarov apparatus can be used.

When a false joint is formed between bone fragments, a three-joint resection operation with additional excision of the bone plates of each fragment is necessary. Then all parts are connected to each other using a special screw. The next step should be competent rehabilitation.

Important! Regardless of the type of fracture, its severity and method of treatment, resting on the injured leg is strictly prohibited. This will not only worsen the condition and prolong the recovery period, but may also lead to displacement of bone fragments.

Using an orthosis

To speed up the recovery period for heel fractures, it is often recommended to use a special ankle joint brace, which is called a “28f10 heel-relieving orthosis.” Orthoses are commonly called external therapeutic and prophylactic devices used for injuries to the musculoskeletal system.

The devices can consist of an elastic fabric with additional inserts or special materials (turbocast), which provide the entire structure with the necessary rigidity for maximum fixation. They are often equipped with lacing or straps.

Advantages of using orthoses for heel fractures:

allow you to support the longitudinal arch of the foot by covering the metatarsal bones and transferring part of the support to the ankle;
provide reduction of loads on the heel bone;
allow the foot to roll, similar to the physiological one;
help reduce pain and shorten rehabilitation time;
help quickly restore motor activity;
reduce swelling by lower limb and minimize muscle atrophy.

When wearing an orthosis, the foot is in almost a physiological position, which is a good prevention of complications in the form of flat feet.

This device allows for active movements that increase blood flow. As a result, the risk of post-traumatic osteomyelitis, arthrosis and osteoporosis is reduced.

Another undeniable advantage is the ability to independently remove the clamp from the leg. For example, to wash a limb. The clamps weigh a little and do not cause any inconvenience. In the orthosis, you can walk without crutches and freely use a variety of ointments. You can walk freely in it and even ride a bike.

Terms of use

Basically, an orthosis for heel fractures is necessary during the period of treatment and rehabilitation measures, which on average last about three months. It is often prescribed after the cast is removed to speed up the recovery process.

Important! All orthoses are sold disassembled; their direct fitting to the leg and assembly must be carried out exclusively by a specialist.

The use of a retainer requires compliance with certain rules:

used only with the permission of the treating doctor;
the size is selected individually;
application is possible only in the absence of plaster, open wounds or swelling;
Gradually, the load on the leg can be increased, guided by the recommendations of the treating doctor and the instructions for the brace;
While wearing, you should put a load on the affected limb, but only in the absence of pain.

Recovery period

The rehabilitation period for a fracture in the heel bone should include a full range of measures:

massage;
physiotherapy;
physiotherapy;
proper nutrition.

The main objectives of all procedures are to improve blood supply to damaged tissues, quickly eliminate signs of inflammation and accelerate regenerative processes. For this, massage sessions with cedar oil, thermal procedures with ozokerite and regular exercises with rising on your toes and then lowering onto your heels will be useful. Warm baths with sea salt have worked well.

As a balanced diet for a heel fracture, foods high in vitamin D, calcium, phosphorus, silicon, copper and zinc will be useful. These can be dairy and fermented milk products, sea fish, meat broths, legumes, eggs, potatoes and bananas.

Possible complications

If therapy is not started in a timely manner, all doctor’s instructions are not followed, or severe cases of heel fracture, the likelihood of complications increases several times. Possible problems include:

flat feet of a post-traumatic nature;
development of arthrosis in the area of the subtalar joint and the joint formed by the talus and navicular bones of the foot (Chopard);
pain when putting pressure on the foot;
formation of heel spurs and bone protrusions;
violation of support.

With chronic fractures, there is a high probability of deformation of the foot, an increase in the transverse dimensions of the heel bone, and the inability to actively move the thumb of the lower limb, and in especially severe cases, all the toes on the foot.

From all of the above, it becomes clear that heel fractures are a serious injury that requires a careful approach and appropriate treatment.

Good to know about this

After observing patients with various heel fractures, orthopedists and surgeons made quite important conclusions:

With closed simultaneous reduction and in the case of a comminuted fracture, there is a high probability of subsequent disability.
For a specific and accurate picture, radiography should be performed in five projections and, if possible, in a high-profile specialized institution.
Skeletal traction should be used only as a preparatory step for a three-joint resection operation.
Relief from chronic pain and complete restoration of supporting function is possible after surgery for resection of the talocalcaneal and Shopar joints.

Restoring sensation and motor activity to the fingers of the lower limb is possible by cutting the long extensors.

On a note

It must be remembered that after the final restoration of all functions of the lower limb in the foot area after a fracture, there is no need to immediately stand on heels or wear tight and narrow shoes.

For six months, preference should be given to orthopedic shoes with appropriate instep support. IN in some cases This period lasts for up to a year.

If flat feet or shortening of the foot occurs, it is necessary to make special shoes based on casts of the foot. It will be useful to visit a specialized sanatorium for spa treatment and follow the principles of proper nutrition for at least six months.

The heel bone is quite strong, it is not easy to break it, but if it is broken, serious problems will arise, since movement will simply become impossible. Do not assume that the possibilities human body are limitless, exposing the body to excessive stress. Even a broken bone can change your quality of life for the worse. It’s worth taking care of your body and directing your strength in the right direction.

A calcaneal fracture is a rare type of injury, accounting for 1.5% of the total number of injuries to the musculoskeletal system. The structural features of the foot and heel bone, as well as the appearance, cause difficulties in treating and restoring the functioning of the foot.

Depending on the mechanism of the fracture, the traumatologist or surgeon prescribes conservative treatment using a plaster cast “boot”. Or he directs the patient to surgery for the so-called reposition of fragments of the calcaneal bone when displaced. During rehabilitation, an orthosis is used for a fracture of the heel bone - a special device designed for accelerated restoration of the structure of the foot and its functions.

Restoration of damaged bone occurs in several stages and requires long-term rehabilitation.

About the fracture

Injuries are not that rare. But a calcaneal fracture occurs as a result of the following factors:

Jump on straight legs from a height (in most cases).
Industrial or domestic injuries accompanied by bone compression.
Road accidents and sports injuries.
Fatigue fractures (microcracks caused by repeated functional overload of the heel - for example, during drill training among soldiers).
Osteoporosis in older people, when bones become fragile and cannot withstand even the usual loads (walking, going up and down stairs, etc.).

A fracture of the calcaneus is most often diagnosed, according to a survey of victims, after they have fallen or jumped from an elevation, landing on straight legs.

Often this type of injury is combined with a fracture of the metatarsal bone, ankle, and spinal injuries in athletes.

Depending on the nature of the traumatic impact, in practice there are the following types fractures:

Fragmented.
Compression.
Hammered.
Isolated.
Regional.

A crushed fracture is quite severe, because in this case the heel bone, due to a strong damaging effect, is divided into several fragments (fragments). The nature of the injury leads to their displacement, in which the fragments diverge in different directions from each other. Such damage requires reposition - restoration of the correct position of all components of the bone. In severe cases, an operation is prescribed in which metal spokes and splints are inserted into the leg.

A compression fracture, in which a crack forms in the heel bone, is easier to treat and in most cases it is treated conservatively. The same can be said about an impacted fracture. However, in severe cases, the method of skeletal traction with the help of special traction weights is used. This is a complex treatment method that requires a highly qualified surgeon.

Symptoms

As with any fracture, damage to the heel bone is expressed in acute pain, and is also accompanied by limited mobility of the foot. Other characteristic symptoms are:

Varus or valgus deformity of the heel.
Inability to shift the center of gravity of the body to the injured foot.
Severe swelling of the foot.
Bruising in the heel area.
Tension of the Achilles tendon.
Limitations of mobility of the subtalar joint.

An accurate diagnosis of a calcaneal fracture is made only on the basis of an x-ray examination of the foot in axial and lateral projection. Depending on the results of the examination and the type of injury identified, treatment is prescribed.

Consequences

The difficulty in treating this type of bone damage lies in the fact that if the approach is incorrect, a number of complications arise that lead to restrictions in the mobility of the leg, and even disability. Negative consequences of improper treatment:

Muscular atrophy of the foot.
Stiffness in the ankle joint.
Valgus foot deformity.
Deforming arthrosis of the subtalar joint.
Post-traumatic flatfoot.

The main mistake in treating a heel injury is the incorrect application of a cast, which disrupts blood circulation in the foot. In the case of a crushed fracture, this leads to irreversible consequences for the patient’s health.

Often due to insufficient blood supply and lack of nutrients, osteoporosis develops, in which the bones of the foot and ankle become brittle.

Orthosis

Traditional methods of treating compression fractures are not used for injuries to the calcaneus, because in most cases they prove to be ineffective and even harmful. For example, in case of a fracture with displacement of bone fragments, a plaster cast “boot” cannot be applied without first restoring the structure and repositioning (putting the fragments in place). In other cases, the use of a plaster cast is allowed, but in this case a special instep support is installed to allow the damaged bone to recover correctly.

The period of foot rehabilitation after healing of the heel bone can be significantly shortened and made easier. orthosis for heel fracture. It is a special prefabricated structure that is fixed on the ankle and ensures the anatomically correct position of the heel bone and other parts of the foot.

Main functions of the heel orthosis:

Minimize the load, especially in the early stages of rehabilitation.
Eliminate atrophy from inactivity of the muscles of the foot and ankle.
Restore foot function as much as possible.

The rigid design of the orthosis in its original form is a set of parts that are individually assembled and adjusted by a specialist in an orthopedic office. But at the same time, there are no differences between women's and men's orthoses: in practice, only three sizes are used for the right and left legs, corresponding to standard numbers (from 37 to 46 sizes).

The selection of this device should be made only by a qualified doctor, who, after examining the patient, issues a written direction for the purchase of an orthosis. Oral recommendations from a doctor are not grounds for purchasing a fixative.

Principle of operation

The design of the orthosis is very rigid, due to which the ankle joint is securely fixed in the anatomically correct position. Special inserts, which the specialist changes as the foot deformity is corrected, allow you to gradually increase the load on the heel bone, reducing the likelihood of a new injury.

This design has a number of advantages:

The rehabilitation period is reduced by 2 times (for example, from 24 to 12 weeks).
When wearing the device, compensation for the height of the shoe on the healthy leg is not required.
The orthosis can be removed and put on independently without visiting an orthopedist (for example, if you need to wash your leg or apply a medicinal ointment).
The device allows you to ride a bicycle and perform other acceptable exercises using the injured leg.

The 28f10 orthosis, as this design is also called, supports the longitudinal arch of the foot, firmly grasping the metatarsal bone and the base of the calf muscle. This is its main advantage over the “boot” plaster cast. Indeed, in such a brace, the foot takes on a physiologically correct position with natural bends. At the same time, the patient gets the opportunity to more actively use the leg when walking, which speeds up the rehabilitation process. Thanks to this, blood circulation is quickly restored, blood stagnation is prevented, and the risk of vein thrombosis is reduced.

According to all the rules, the selected orthosis ensures a physiologically correct roll of the foot.

Contraindications

First of all, you need to remember that if you do not have a written prescription from the attending traumatologist or surgeon, you will not be able to buy it. Indeed, despite the fact that this rehabilitation device is indicated in most cases, there are still several restrictions on its use. And the doctor always takes them into account.

When you should not wear the 28f10 brace:

If the healing process is not yet complete and the patient's leg is still in a cast.
If there is significant swelling of the foot or ankle.
If there is an open wound in the area where the fixator is applied.

The 28f10 brace can be used in the early stages of rehabilitation, immediately after removal of the plaster cast. But the orthosis must be purchased at a specialized institution and an appointment with an orthopedist must be made.

The presence of the patient during assembly and adjustment of the fixator is required. The average cost of fitting work is 1500–2000 rubles.

Wearing an orthosis for a heel fracture during the recovery stage will make the rehabilitation process as easy and simple as possible and minimize the negative consequences of the injury. The patient is instructed to use and develop the leg as intensively as possible to minimize the likelihood of atrophy. Walking at a moderate pace and light exercise are recommended. True, with early motor activity of the injured foot, it is important that movements are not accompanied by pain. If you experience any discomfort or pain, you should immediately consult your doctor to prevent the development of inflammatory process or heel deformities.

In parallel with wearing an orthosis for a heel fracture, the patient is prescribed:

Medicinal physical exercise(physical therapy). They are aimed at developing the muscles of the foot and ankle, which have been immobile for a long time.
A massage that should be performed by a specialist in a therapeutic gymnastics office.
The patient is recommended to independently develop the leg by performing simple exercises: heel-to-toe rolls, ankle rotation, etc.
If your leg swells after removing the cast, it is recommended to take foot baths with sea salt. Rubbing in Troxevasin and Lyoton 1000 ointments helps. And only then the orthosis is put on.

For accelerated healing and recovery of the leg, a diet enriched with calcium and protein is recommended. The main emphasis is on dairy products, lean meat and fish, and eggs. Taking multivitamin calcium-containing preparations helps speed up healing: Calcium D3-Nycomed, Teraflex, Calcimin.

Heel injury occurs rarely, accounting for 1.5% of all traumatic cases. An orthosis for calcaneal fractures is often used and brings good results. Using a brace is better than using a cast because it completely secures the foot in its natural position. This is significant, since the product prevents the development of flat feet during leg restoration.

Foot brace

To speed up the recovery period after surgical interventions, use product brand 28F10. Orthoses are external devices of a therapeutic and prophylactic nature, used to treat damaged areas of the musculoskeletal system. Advantages of devices:

They hold the arch of the leg, covering the metatarsal bone, and partially transferring the support to the ankle.
Reduces the load on the heel bone, which is important for maintaining the natural roll of the feet.
Reduces foot pain.
Accelerates the rehabilitation process, the bone heals more effectively, helping to resume active movements.
Prevents muscle fiber atrophy, reduces swelling.

Indications for use

The use of an orthosis for a heel fracture allows you to comfortably and quickly go through the rehabilitation stage after difficult procedures. The main purpose of using the orthosis:

The device is placed on a limb when the heel is fractured.

worn before surgery on the talocalcaneal plexus;
fixation after a unilateral or bilateral type fracture on the heel;
preparation for the stage of arthrodesis of the heel joint.

Types of orthoses for calcaneal fractures

Clamps come in different operating principles:

by area of influence;
by type of destination;
according to the manufacturing method.

Area of application: for the spine, for plexuses (knee brace, heel bone support). It does not matter if the heel fracture is bilateral or unilateral, a brace will fit in both cases. The orthopedist writes out either individual indicators for a special order for the manufacture of the device, or prescribes a specific type of fixator. Universal orthoses are manufactured in a factory with a specified size. When the finished product is indicated, the patient can choose the material and fixative himself, relying on his capabilities and tastes.

Instructions for use

The recovery period after injury lasts about 3 months. During the rehabilitation period, an orthosis is prescribed for effective treatment joint Often, a fixative is prescribed after the cast is removed to speed up the recovery process. Rules for using the orthosis:

If the leg does not bother you, then you can gradually step on it.

use according to a doctor's prescription;
individual size selection;
use provided there is no plaster application;
no open wounds or swelling in the damaged area;
gradual increase in load force; the foot is allowed to be loaded only in the absence of pain.

Orthoses are sold unassembled; individual adjustment to the foot and assembly is carried out only by a specialist.