Calcaneus fracture or lover's fracture results from an axial load type of injury. The Calcaneus connects to the talus, which is the largest bone in the ankle. The tendons connect the muscles to the various bones of the toes and feet, which help to stand and walk. Speedy motor vehicle accidents or falls from great height might lead to calcaneus fracture. Acute pain, centered on the outer side of the ankle just below the lower leg bone is a symptom of Calcaneus fracture. This pain may be centered on the outer side of the ankle just below the lower leg bone. Sometimes the pain may focus in the heel pad. The pain becomes acute when weight is placed on the foot. The foot becomes swollen and stiff.
Sometimes it gets very difficult for the physician to diagnose a Calcaneus fracture clinically, as there may be no obvious deformity. Radiographic examinations are essential and helpful to confirm fracture of the Calcaneus. Lateral X rays of the foot are needed to evaluate the Bohler's angle in Calcaneus fractures. X ray of the lower back is also advised to see if there is a fracture there. CT scan aids in diagnosis and treatment of Calcaneus fractures.
Extra articular Calcaneus fractures: Extra articular Calcaneus is more common in people with diabetes. Extra articular Calcaneus fractures are generally treated in a closed manner. Short leg casting and no weight bearing for about two weeks followed by a range of motion exercises are normally prescribed for non displaced extra articular Calcaneus fractures. Extra articular Calcaneus fractures are further sub divided into those involving anterior process and those of the tuberosity. In elderly patients, due to osteoporosis and weakening of bones, sudden contraction of the gastrocnemius muscle occurs. Achilles gets displaced upwards. In young patients extra articular Calcaneus fracture occurs due to significant fall.
Intra-articular Calcaneus fractures: Intra articular Calcaneus fractures are initially treated with a bulky dressing with the foot elevated to the level of the heart and wrapped to keep the bones from shifting and elevation to control edema. Ice massages and packs help reduce swelling and pain. The physician applies a splint till the swelling reduces. Other treatment options for Intra articular Calcaneus fractures are a combination of open reduction, osteotomy, and internal fixation, arthrodesis of the subtalar and calcaneocuboid joints.
Surgical option becomes necessary if the bones have shifted out of place and there occurs a displaced Calcaneus fracture. A metal plate and small screws are used to hold the bones in place. Sometimes a bone graft is done to aid in the healing of the fracture. One should remember that it should take a tremendous force to break the heel bone. Therefore, even if the fracture heals, the foot may never be the same as it was before the injury. The patient may continue to experience stiffness and should wear a heel pad, a lift or a cup and special shoes if necessary. Calcaneus fractures with broken heel can be traumatic. Although the recovery can be short, it takes more than a year to heal.
The talus is a turtle-shaped small bone that sits between the heel bone calcaneus and the two bones of the lower leg, the tibia and fibula. Over half of the talus is covered with cartilage. The talus is an important connector between the foot and the leg and the body. It helps to transfer weight and pressure across the ankle joint. Therefore any injury to the talus affects the ankle and the subtalar joints and multiple planes of movement of the foot and ankle are also affected. It is interesting to note that the first series of talus fractures was described in men injured in the British Royal Air Force in early 1900, when the old war planes made crash landings. The term aviators astragalus was used to describe what we now call talus fracture. Typically causes for talus fracture include fall from heights, motor vehicle collisions and injuries of the lower back.
Persons suffering from talus fracture experience acute pain and considerable swelling and tenderness in the affected area. There is inability to bear weight. Often this type of fracture is mistaken for ankle sprain. A physician relies on x rays of the foot and the ankle to ascertain the nature and kind of talus injury. In some cases, if x ray does not reveal the nature of the fracture, a CT scan is requested. Fractures in the talus can occur:
Fractures of the talus are rare but when they occur they are highly complicated. Since talus has no muscle attachment and peculiar blood supply, high morbidity in the form of non-union and mal union can occur. Avascular necrosis, which means partial death of the bone, leading to a painful arthrosis condition is another common complication.
Immediate first aid has to be rendered to patients from talus fractures. A well-padded splint around the back of the foot and leg from the toe to the upper calf is placed. Foot must be elevated to the level of the heart to prevent further edema. Ice packs can be applied every twenty minutes till the physician arrives. Care should be taken not to put weight on the injured foot. Untreated talus fractures can create problems later. The foot may get impaired and the patient is at risk of developing arthritis and chronic pain. The bone may even collapse in certain cases.
Often talus fractures require surgery to minimize the complications from arising later. The surgeon realigns the bones surgically and uses metal screws to hold the pieces in place. Small fragments of bone can be removed by bone grafts which are used to restore the structural integrity of the joint.
Even after a good correction surgery, there is always the danger of deformity, arthritis and other conditions like lack of blood supply to the talus bones. The ability of the ankle to move can be affected if ankle arthritis occurs. Subtalar arthritis that is arthritis in the subtalar joint beneath the talus bone is another complication. Deformity of the foot is another problem of talus fracture. When the fracture is fixed, it becomes difficult to reposition the bone correctly and deformity may occur.
Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retro ocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.
Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.
The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.
Bibliography / Reference
Collection of Pages - Last revised Date: July 20, 2018