Heel bone fracture OP

There are two ways to treat a calcaneal fracture. Firstly, there is the conservative treatment method, in which the leg is placed high up and is sufficiently decongestant during cooling and lymph drainage to allow the fracture to heal on its own. More often, however, a heel bone fracture is recommended to be treated by surgery.

When operating on a calcaneal fracture, the surgeon must first know the initial position of the fracture.Small fractures can be treated with wires or, more frequently, with plates, while open calcaneal fractures should be treated with a so-called external fixator, as this ensures maximum stability. Prior to surgery for a calcaneal fracture, the swelling in the foot must first have decreased significantly. Before surgery can take place, the patient has to put the foot up for about a week, cool it with ice and receive a lymph drainage.

Only after the swelling has subsided sufficiently can surgery be performed on the calcaneal fracture. During the operation, an incision of about 4-5 cm is made on the outside of the calcaneus. The patient therefore lies on his side during the operation so that the surgeon has a better view of the calcaneus.

In order to avoid too much bleeding, a so-called tourniquet is often applied in the thigh area. In order to obtain a good view of the heel bone fracture and the lower ankle joint, fat layers and muscles must first be prepared freely during the operation. Only then can the surgeon obtain a good view of the calcaneal fracture.

If there are small bone splinters, these are removed. The calcaneus is then reconstructed and reassembled so that it retains its physiological shape and the fragments lie as close as possible to each other in order to heal better. Usually a titanium plate is then placed on the affected fracture site, which is then fixed with screws.

Patients at high risk of wound healing disorders (smokers, chronic venous insufficiency, diabetics…) are sometimes treated with small incisions through which wires are inserted to stabilize the calcaneus. However, surgery for a calcaneal fracture using a titanium plate and screws is safer and more frequently used. The wound is then closed again and the patient is then admitted as an inpatient for about a week.

A calcaneal fracture is a serious fracture which should not be taken lightly as there are patients in whom the fracture does not heal properly despite adequate treatment. Especially late consequences such as early wear and tear of the joint (arthrosis) can lead to the fact that the duration of the calcaneal fracture does not only refer to the actual phase of bone growth but that the calcaneal fracture leads to a permanent change of the life circumstances. Depending on how severely the calcaneus is fractured, conservative therapy or surgical treatment is preferred.

The duration of healing in the case of a calcaneal fracture thus also depends on the type of therapy chosen. In patients with a “straight” fracture or in patients who could suffer from wound healing disorders due to previous diseases such as diabetes mellitus, conservative therapy is preferred. Here, the foot is elevated, cooled and painkillers are administered.

In addition, a lymph drainage is performed to reduce the swelling in the foot. With this conservative therapy, the healing time of the heel bone fracture is about 6-12 weeks. In younger patients, in whom the calcaneus has broken through for the first time, 6 weeks are usually sufficient.

In older patients, who may have accompanying diseases such as diabetes, the healing time can then be longer than 12 weeks. It is also important to know that even after 12 weeks the healing process may not be complete and that the healing process may then come to a halt and the patient has to live with the late effects. Normally, however, after 12 weeks of healing, the patient should be able to put full weight on the foot again.

In most cases, however, the surgical procedure is preferred. Before the operation, the foot must first be decongested by putting it up and cooling it. This takes about one to two weeks.

Also with the surgical procedure, the healing time after the operation is about 6-12 weeks. Physiotherapy can be started after the first week. However, since the complete healing of the calcaneal fracture can take up to 6 months, it is important that the patient does not begin with extreme sports activities such as jogging or playing soccer until after 6 months, otherwise the risk of late complications is too high.