Calcaneus Fracture (Broken Heel)

A calcaneus (kal-KAY-nee-us) fracture, or calcaneal fracture, is a type of bone fracture. It happens when you break your heel bone (calcaneus). Your heel bone is the large bone at the back of your foot.

Calcaneus fractures can be severe fractures that crush your heel bone and damage a nearby joint, cartilage, ligament and tendons. Less serious fractures are calcaneus stress fractures.

Orthopedic surgeons and podiatrists are healthcare providers who specialize in diagnosing and treating broken heels.

Types of fractured heel bones

The types of fractured heel you have depends on the amount of damage to your heel:

• Intra-articular fractures: This fracture is when you break your heel bone and damage the subtalar joint and cartilage. Your subtalar joint is where your ankle bone meets your heel bone. Intra-articular fractures are the most severe type of broken heel. Severe calcaneus fractures are medical emergencies.
• Extra-articular fractures: Some extra-articular fractures are less serious than intra-articular fractures. They don’t damage the joint or cartilage near your heel bone. But an extra-articular fracture can be a serious medical issue. For example, a heel fracture that pulls a small piece of bone away from your heel bone is a medical emergency. That’s because this fracture type can damage your skin and lead to serious complications.
• Calcaneal stress fractures: A stress fracture is when you have one or more small breaks in your heel bone. Overuse is the most common cause. The stress can cause intense pain and make walking more difficult. It’s important to see your healthcare provider right away if you have a calcaneal stress fracture or think you could have one. Treatment can help you avoid further damaging the broken bone.

Heel bone fracture symptoms

Calcaneus fractures and calcaneus stress fractures cause different symptoms. In general, calcaneus fractures cause more serious and painful symptoms than calcaneus stress fractures.

Intra-articular and extra-articular calcaneus fracture symptoms

Intra-articular and extra-articular calcaneus fractures may cause the following symptoms:

• Sudden severe heel pain
• Difficulty walking or putting weight on your heel
• Difference in the way your heel looks (your heel may look wider than usual)
• Difficulty moving your foot
• Bruises on your ankle and heel, or hematoma and bruising on the sole of your foot
• Numbness or tingling if the broken bone presses on nearby nerves
• Swelling

Sometimes, pieces of a broken heel bone break through your skin (compound fracture). This is a medical emergency. Call 911 (or your local emergency services number) or have someone take you to the emergency room.

Calcaneus stress fracture symptoms

Calcaneal stress fractures cause heel pain that gets worse when you put pressure on your heel. For example, standing for a long time may make your heel hurt. The pain eases when you’re not being active. Stress fractures develop over time. You may notice a twinge in your heel that slowly becomes more noticeable. Other are:

• Bruising
• Stiffness
• Pain that gets worse when you stretch your foot or stand for a long time
• Your heel feels tender or warm to your touch

Calcaneal fracture causes

All calcaneus fractures happen when you damage your heel bone. But calcaneus fractures and calcaneus stress fractures have very different causes.

For example, intra-articular and extra-articular calcaneus fractures often happen because you have a traumatic injury from:

• Falling from a high place, like a rooftop or the top rung of a tall ladder
• Vehicle accidents, especially if you crash while driving very fast

These types of fractures can happen during a crash because you push your foot down on the floorboard, brake or accelerator. Force from the crash can crush your heel bone.

Any motion you do over and over can cause a calcaneus stress fracture. The condition often affects people who walk, jog or run a lot. You may get a calcaneus stress fracture if you play sports that involve a lot of running back and forth, like basketball, soccer or tennis.

Complications of calcaneus fractures

Calcaneus fractures and calcaneus stress fractures are very different injuries that may lead to different types of complications.

Intra-articular and extra-articular calcaneus fractures and treatment may cause the following complications:

• Arthritis in your subtalar joint
• Bone infection (osteomyelitis)
• Compartment syndrome (buildup of pressure on your muscles that reduces the flow of blood, oxygen and nutrients to your muscles)
• Surgical wound infection
• Malunion (your broken heel bones heal in the wrong position) and foot deformity

Without treatment, malunion and foot deformity may cause ankle pain and ankle arthritis.

Calcaneus stress fracture complications are less serious than complications from a calcaneus fracture and treatment. Complications may include:

• A change in how you walk (gait)
• Pain
• Stiffness

How doctors diagnose calcaneal fractures

Doctors take different steps to diagnose calcaneus fractures. You may work with a podiatrist to find out why you have heel pain that comes and goes. Orthopaedic surgeons, trauma surgeons or podiatrists with special training in hindfoot and ankle surgery typically diagnose and treat more severe fractures.

Diagnosing calcaneus fractures

Most calcaneal fractures are traumatic injuries. That’s why you may receive your diagnosis and initial treatment in an emergency room. A surgeon will ask how the injury happened. They’ll examine your foot and ankle. Then, they’ll do imaging tests. The surgeon may do more tests to look for issues that a fall or vehicle crash can cause.

Studies show people with calcaneal fractures often have spinal compression fractures and tibial plateau fractures (a broken bone in your knee).

A podiatrist or sports medicine physician may diagnose a calcaneus stress fracture. They’ll ask about your symptoms and how long you’ve had them. They may ask about your daily routine and activities.

They’ll examine your heel and ankle. They may also check if you can feel sensations on the bottom of your foot.

Tests to diagnose calcaneal fractures

Your healthcare providers may do imaging tests like:

• Foot X-ray to check your heelbone
• CT scans to see how the injury affects your heel bone and to rule out any joint injuries
• MRI scans to see if the injury affects your ligaments or tendons (they may do this test to check for stress fractures)

How are calcaneus fractures treated?

Your treatment will depend on the type of fracture. In general, surgery is treatment for calcaneus fractures where pieces of your bone are out of place, damage your subtalar joint or move enough to form a gap.

If you need surgery, your orthopedic or podiatric surgeon will do an open reduction and internal fixation. Your surgeon will make an incision (cut) in your heel. They’ll realign the broken bones. Then, they’ll place screws or plates on the bones to keep them in place while they heal.

You may need more than one surgery to repair a severe calcaneus fracture. You may also need physical therapy if your injury and surgery make it hard for you to move your foot. Physical therapy supports healing, too.

You won’t need surgery for a calcaneus stress fracture. You also won’t need it for a fracture that doesn’t affect your subtalar joint or one where your bone doesn’t move enough to create a gap. Your provider may recommend the RICE method to treat these kinds of fractures. RICE stands for:

• Rest
• Ice
• Compression
• Elevation

Your provider may place your foot in a boot if you have a stress fracture. They may put a splint or cast on your foot and ankle to treat a calcaneus fracture. The cast or splint will protect your heel and keep damaged bones in place while they heal. You’ll also receive physical therapy.

How long does it take for a fractured calcaneus to heal?

That depends on your situation. For example, you may need several surgeries and other kinds of treatment if you have a severe calcaneus fracture that damages your subtalar joint. In that case, it may be months or years before you completely recover.

Most people heal from a calcaneal stress fracture within a few months. During healing, you’ll likely wear a boot and limit weightbearing on your heel. After treatment, you may need physical therapy. Therapy will improve your strength and prevent further injury.