The heel is a large bone that forms the foundation of the back of the foot. The heel is connected to the ankle and the cuboid bone. The joint between the ankle and the heel is the subtalar joint, which is important for the normal function of the foot.
The heel is often compared to a boiled egg as it has a thin, hard shell on the outside and softer, spongy bone on the inside. When the outer shell breaks, the bone tends to collapse and fragment. For this reason, heel fractures are serious injuries. In addition, if the fracture involves the joints, there is the potential for long-term consequences, such as arthritis and chronic pain.
Most heel fractures are the result of an injury – most commonly, a fall from a height, such as a ladder, or in a car accident where the heel is crushed against the floor of the vehicle. Heel fractures can also be combined with other types of injuries, such as a sprained ankle. A smaller number of heel fractures are fatigue fractures, caused by overuse or repetitive stress on the heel.
Heel fractures can extend to the subtalar joint and adjacent joints. Intra-articular fractures are the most serious heel fractures and involve damage to the articular cartilage. The outlook for rehabilitation depends on how severely the heel was crushed at the time of injury. Extra-articular fractures include avulsion fractures, comminuted fractures and fatigue fractures. The severity and treatment of extra-articular fractures depend on their location and size.
Heel fractures cause sudden pain in the heel and inability to load the affected limb, swelling in the heel area and bruising in the heel and ankle. The diagnosis is based on radiological examination. The CT scan assesses in detail the degree of crushing and the intra-articular extension of the fractures.
Treatment of heel fractures is dictated by the type of fracture and the extent of the injury. For some fractures, conservative treatment may be used, which includes rest, ice therapy, compression and immobilization of the limb. Unloading (crutches) of the affected leg is required to allow the fracture to heal. Ice reduces swelling and pain. A shin splint is usually needed to prevent movement of the broken bone. For comminuted or intradiscal fractures, treatment often involves surgery to rebuild the joint, or in severe cases, arthrodesis.
Heel fractures can be serious injuries that can cause lifelong problems. They often develop arthritis, stiffness and chronic joint pain. Sometimes the fracture does not set in the correct position. Other possible long-term consequences of heel fractures are reduced foot movement and lameness due to collapse of the heel bone and subsequent imbalance. Patients often require additional surgery and/or long-term or permanent use of a guardian or orthopedic foot orthosis to manage these complications.