Broken heel bone

This article describes the causes, signs, and treatment of a broken heel bone, also called a fracture of the hindfoot. The heel bone (calcaneus) forms the heel of the foot. When standing or walking, this bone bears a large part of the body's weight.

The foot consists of no fewer than 28 bones. Starting at the ankle are the tarsal bones, including the talus and the heel bone, followed by the metatarsal bones and, finally, the toes.

There are also articles with more information about a broken toe and a broken metatarsal.

How does a broken heel bone occur?

In most cases, a heel bone fracture is a direct result of a hard landing on the heel during a fall or a jump. Sports such as long jump or gymnastics therefore increase the risk of a fracture of the heel bone. The fracture also occurs regularly in people who land hard while parachuting.

The heel bone can also break due to a strong pulling force from the Achilles tendon, which attaches to this bone. This is called an avulsion fracture. In an avulsion fracture , the tendon pulls off a small piece of bone. This usually happens when the calf muscles suddenly contract forcefully, but it is very rare.

Signs and symptoms of a broken heel bone

The most important sign of a broken heel bone is sudden, sharp pain. This pain is often so severe that bearing weight on the heel and walking are impossible. Other signs include swelling and discoloration of the skin around the heel.

In severe fractures, the heel is deformed and there may even be an open fracture. In an open fracture, the skin is broken and a wound is visible.

If broken bone fragments shift, a nerve can become pinched. This is one of the causes of the tarsal tunnel syndrome. This is characterized by pain, numbness and tingling on the inside of the ankle.

How is a broken heel bone diagnosed?

A fracture of the heel bone can often be identified after a patient interview and a physical examination. Touching the heel bone and moving the ankle and foot will worsen the pain.

To be sure the heel bone is broken, an X-ray is taken. This X-ray also provides more information about the severity and location of the fracture. When an X-ray does not provide enough clarity, a CT scan follows. This creates a 3D image of the foot, allowing the fracture to be viewed clearly from all sides.

Treatment of a broken heel bone

Surgery may be necessary to repair the bone fragments. The surgeon will determine this after reviewing the images. If bone fragments have shifted, they need to be repositioned. In that case, osteosynthesis is performed. The surgeon uses plates and screws to hold the bone fragments together. The lower leg and foot are then placed in a cast.

Even if surgery is not needed, the foot is immobilized in a cast or a splint for six to eight weeks. The foot must not be loaded during this period. It is also advisable to keep the foot elevated as much as possible to reduce swelling. This also helps reduce pain.

After the casting period, the ankle will feel quite stiff. It is important to restore joint mobility and rebuild muscle strength. The physical therapist is the ideal professional to guide this recovery, largely through exercises and mobilizations.