General
The heel bone is the largest tarsal bone and resembles the shape of a cuboid. The calcaneal fracture is a typical fracture due to a fall from a great height and a vertical compression. In calcaneal fracture therapy, both conservative and surgical measures are available, which are chosen depending on the type of fracture.
Three different types of calcaneal fracture can be roughly distinguished: The “duck’s beak fracture”, in which part of the calcaneus is broken by excessive pulling of the Achilles tendon, “joint depression“, which is more of a type of impression fracture, and the “tongue type”, in which the fracture line runs almost horizontally through the calcaneus. Typical symptoms of a calcaneal fracture are pain in the heel area and significant swelling. The soft-tissue swelling at the heel can even cause the part of the foot to widen significantly, making the shoes no longer fit.
The arch of the foot can also be flattened. The result of the pain is often a functional limitation in that no movement is possible on the heel and no mobility of the ankle joint. As a result of the fracture, a hematoma usually develops at the heel. Accompanying injuries are also not to be neglected.
Cause
A type of heel bone fracture can develop through direct exposure to force or simply by bending over. However, the typical courses of accidents or injury mechanisms are directly related to axial force effects. For example, these forces occur when falling or jumping from a great height, or in a car accident if you hit an obstacle head-on and the heel is crushed. The type of heel bone fracture that occurs depends on the foot position at the moment of compression.
Diagnosis
A calcaneal fracture can be diagnosed using various methods. On the one hand, the course of the accident usually indicates this, for example, if there has been axial compression or a fall from a great height. In addition, the suspicion is reinforced by the fact that the heel hurts and cannot be loaded.
A good imaging measure to confirm the diagnosis and for exact localization is a conventional x-ray of the heel bone in two planes. In the case of a calcaneal fracture, for example, cracks in the bone or step formations would be visible. It is also important for the treatment method to know whether the calcaneal fracture is dislocated, i.e. whether individual fragments are displaced or not. If surgery is necessary to treat the fracture, computer tomography can be performed as part of the planning to get a better impression of the fracture lines and fragments to be treated and especially of the severity of the fracture.
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