Diagnosis | Heel bone fracture

Diagnosis

In order to make a diagnosis of a calcaneal fracture, the patient is first of all asked exactly what his symptoms are and how they occurred, for example, whether an accident occurred that can be directly linked to the symptoms. The doctor then examines the heel, looks for any swelling and bruising and checks whether and, if so, how much the mobility of the ankle joint is restricted. If a heel bone fracture is suspected, an x-ray must then be taken in two planes (i.e. once from the front and once from the side).

Often, however, the X-ray image alone is not sufficient to make an accurate diagnosis. Therefore, computed tomography (CT) or magnetic resonance imaging (MRI) is usually necessary. With the help of this procedure, the fracture, including any concomitant injuries, can be assessed more precisely, classified and the further procedure planned on the basis of these results.

Differential diagnosesalternative diagnoses of calcaneal fracture

We have summarized all causes and diagnoses that can lead to pain in the calcaneus in our own topic Pain in the calcaneus. Heel bone fracture therapy depends on the severity and form of the injury. In principle, both conservative (non-operative) and operative treatment are possible for this clinical picture.

First of all, treatment begins at the site of the injury and, as with most traumatic injuries, is based on the so-called “PECH scheme”, which any affected person can carry out himself before consulting a doctor. This stands for: The majority of calcaneal fractures require surgical treatment. Conservative treatment is only preferred if the fracture is uncomplicated (i.e. if there is neither a comminuted fracture nor a joint involvement with a stepped joint surface).

Another reason for purely conservative treatment is when there are contraindications for surgery, for example, when there is a soft tissue infection or when the patient is in poor general condition, which would be associated with too high a risk of surgery. For a patient, this means that a lower leg cast is applied, which he or she usually has to wear for about ten to twelve weeks, and that the leg has to be elevated and cooled for a longer period of time. In addition, medication should be taken that can reduce the pain somewhat and allow the swelling to subside.

If the fracture is displaced (dislocated) and there are no contraindications against surgery, surgery is usually performed. Usually, for fractures with large fracture fragments, wires or plates are used to fix the individual pieces after all elements have been returned to their original position (repositioning). The aim is always to restore the ankle joint to its pre-injured state.

This procedure is called (plate) osteosynthesis. However, any small bone fragments that may have arisen are removed. If the Achilles tendon is torn off (and a small piece of bone may have been torn out in the process), this condition is usually treated by means of screw osteosynthesis. If the joint between the heel bone and ankle bone is involved, parts of the bone may have to be refilled (cancellous bone grafting) to ensure a certain degree of stability.

  • Pwie Pause: an immobilization of the foot and an interruption of any stressful activities
  • Like ice: a cooling of the affected area
  • Cwie Compression: Apply pressure to the painful area, if necessary with a pressure bandage
  • H How to raise (raise foot or leg)