Treating Heel Pain: Calcaneal Fractures
Fractures can be another cause of heel pain. Your heel bone, called the calcaneus, can incur fractures like any other bone. Calcaneal fractures, however, are dangerous because of the physiology of the calcaneus and the bones with which it forms a joint. The breaking of the calcaneus’s thin, yet hard outer shell reveals a softer bone inside that shell. Once the outer shell is broken, the entire bone is prone to collapse and fragmentation. Breaking the calcaneus can have negative effects on the joint it creates with the talus and cuboid bones, bones further of the foot. A fracture that disturbs the joint (inter-articular fractures) can cause damage to multiple bones and the cartilage between, and could have long-term effects including arthritis and chronic pain.
Calcaneal fractures are usually caused by traumatic events: big falls, car accidents and the like. Like other stress fractures, calcaneal fractures can also be caused by overuse or repetitive stress on the heel. Pain can vary, depending on whether the fracture is traumatic or not. Some patients with calcaneal fractures report not being able to put any weight on their foot, and others report pain and symptoms similar to that of plantar fasciitis (general pain growing progressively worse over a number of days or weeks). Calcaneal fractures, however, will produce pinpoint pain after pressing down on the middle or sides of the heel bone, which does not usually occur with plantar fasciitis. Additionally, in your primary assessment and to reach a correct diagnosis, your podiatrist will inquire into your recent activities (since, often, abrupt increases in exercise or sudden weight gain can cause calcaneal stress fractures), and may take an X-ray to examine the bone.
The most important thing to consider when treating calcaneal stress fracturesis the time they take to heal. Do not wait to treat stress fractures, or to visit your podiatrist for a diagnosis. If treated improperly or ignored, stress fractures will only worsen with time or reoccur, even leading to deformities that restrict motion and activity, cause arthritis and make shoes incredibly uncomfortable.
Your podiatrist and you can work together to find the proper treatment plan for your injury, which will likely include a combination of rest, immobilization with a caste or rigid shoe, avoiding the aggravating activity, ice, NSAIDs, physical therapy for rehabilitation, and surgery in extreme cases. Non-operative treatment of calcaneus fractures will range from limiting weight bearing activities and the use of crutches, limiting motion through casting, splinting or bracing for a short period of time, and range-of-motion exercises so that your muscles don’t atrophy and the blood keeps circulating to the healing area that needs it most. Be patient with your injury, as it takes time, usually around three months, to heal stress fractures. In extreme cases, or in the case that you have poor circulation or diabetes, surgical approaches for calcaneus fractures may be a good option for your injury. Be sure to discuss the benefits of surgical treatment with your podiatrist.