Calcaneus fracture

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.

Bone cancer

Bone tumor is an abnormal growth of cells within a bone. Bone tumors may be malignant or benign. Though the causes of bone tumors are unknown, some possible causes include hereditary or genetic defects, radiation and injury. In most cases, no specific cause is found. Osteochondromas is a most common non cancerous bone tumor which occurs in people between ages ten and twenty. While primary bone cancers start from bones, secondary or metastatic bone tumors start in another part of the body such as breast, kidney, lung, prostate and thyroid and spread. These forms of cancer usually affect older people.

Symptoms of bone cancer

Some common bone cancer symptoms include:

• Bone fracture or fracture from slight injury or trauma.
  
• The most common symptom of bone cancer is pain. Though mild initially, bone pain gradually becomes intense and tends to worsen at night.
  
• A mass or lump may be felt on the bone or the tissues surrounding the bone. This is common with fibrosarcoma.
  
• Bones become weakened by tumor and may lead to a fracture. This can occur with both benign and malignant tumors.
  
• Mass swelling at the tumor site which may be occasionally found.
  
• Pain, numbness and tingling in the extremities can be found if tumor is compressed and this can affect the blood flow to the extremities.
  
• Fever, chills and night sweats can occur though these are less common signs.
  
• Weight loss can occur in some cases.
  

Diagnosis of bone cancer

After taking into account the complete medical history and performing a physical examination, the following diagnostic tests would be done.

• Alkaline phosphatase blood test.
  
• CT scan can give a cross sectional picture of the bones and additional information on the size and location of the tumor.
  
• MRI of the bone and surrounding tissues can provide cross sectional imaging of the body and better details of soft tissues, including muscles, tendons, ligaments, nerves and blood vessels.
  
• X ray of the bone and surrounding tissues.
  
• A bone scan is taken on the entire body and is not specific for any type of tumor.
  
• Bone biopsy: When the tumor is identified, the doctor may then obtain a biopsy sample of the tumor. This involves taking a small sample of the tumor and examining it in the laboratory by a pathologist. This biopsy can be obtained through a small needle or through a small incision.
  

Treatment of bone cancer

There are many treatment options for bone cancer depending upon the type of bone cancer and the location of the cancer. It also depends on whether or not the cancer has spread from the bone to surrounding tissues. Treatment options include surgery, chemotherapy and radiation therapy. These can be used individually or in combination with each other.

Although some benign bone tumors tend to go away on their own and hence do not require treatment, close monitoring is essential to see if the tumor shrinks or grows. In case of malignant tumors, surgery would become essential. The goal of surgery is to remove the entire tumor and its surrounding area or normal bone. A pathologist examines the tumor once removed to determine if there is normal bone completely surrounding the tumor. In case the cancer is left behind, chances are it can continue to grow and spread requiring further treatment.

Depending upon the size/amount of bone removed, the surgeon will replace either by bone cement or bone graft from another place in the body or from the bone bank. For larger areas, larger grafts from the bone bank or metal implants are done. Historically, amputation was the technique used to remove bone cancer. However, new techniques adopted have significantly decreased the need for amputation. Treatment for cancers that spread from other parts of the body would depend upon where the cancer started.