Calcaneal Fracture

One of the bones you really don't want to break.

By Marven Ewen, MD
Medical Director

I was seeing a middle-aged tradesman. He told me how he misjudged the last couple of steps of the ladder and ended up dropping onto his right foot with his knee in a fully extended position. He was wearing stiff boots and landed on a concrete floor. 

 

All the force of the fall was transmitted up through his heel bone. Even though it was a relatively short fall, he was unable to walk or even stand up due to the severe pain. He denied any other injury.

 

You might be surprised to learn that the calcaneus, or heel bone, fracture can be one of the most devastating orthopedic injuries. Although heel fractures are fairly uncommon, they can result in a very long recovery which may result in a change in occupation. It is not uncommon for a patient to take a year or more to recover from a fractured heel. 

 

Heel fractures result from a sudden and severe axial load applied to the foot, such as a fall or jump from height. I have seen a calcaneal fracture from a fall of as little as three feet, as in the case noted, but more often from a fall of greater height. The higher the fall, the more likely there will also be associated injuries, especially injuries to the lower spine and extremities.

 

Typically patients with a heel fracture will complain of severe pain and not be able to bear weight on the affected heel. When evaluating these patients, be sure to rule out associated injuries. Ensure, as in all cases of trauma, that ABCs and vitals are normal. Also check CMS to the affected foot and note swelling and tenderness around the area of the heel. 

 

Apply a bulky dressing or pillow to protect the heel on transfer. The foot should be elevated and an ice pack applied to help control pain and swelling.

 

This patient underwent a CT of his foot which both confirmed the presence of the fracture and demonstrated it was intra-articular involving the subtalar joint.  Even though he had appropriate orthopedic management, he had a very prolonged recovery and ended up retraining for a desk job as he was no longer able to be on his feet all day.

More from The Allied Times

A Close Shave

A Close ShaveHow shaving can trigger a cardiovascular response.By Marven Ewen, MDMedical DirectorThe day started out fairly quiet in the ER. Pretty good for early Sunday morning. All the usual Saturday night characters had been discharged or admitted. That is when the local EMS service rolled up with an elderly male patient. His story was he…

Progeria

ProgeriaThe accelerated aging disease.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewThe concept of accelerated aging sounds like it belongs in movies, but there is a rare and fatal condition that is recognized by its main symptom: accelerated aging in young children. Hutchinson-Gilford Progeria Syndrome (also called Progeria or HGPS) was first written about in England in the nineteenth…

Staying Safe

Staying SafeEMTs save lives – including their own life.By Marven Ewen, MDMedical DirectorI walked into the doorway of the psych interview room. Standing near the partially open door, carefully choosing my words, I made it clear to the patient and his girlfriend that no, we would not be admitting him to the hospital as he…

Measles

MeaslesThe world’s most contagious disease.By Jenny Ewen, BA, NREMTEditor-In-ChiefA Short History Measles was identified as the result of a virus in the 18th century, but it was first mentioned in the 9th century by a Persian doctor. By 1912, measles was a notifiable disease in the US so all diagnosed cases were reported – in the…

Close Encounter With a Bat

Close Encounter with a BatA cautionary tale about the risk of rabies.By Marven Ewen, MDMedical DirectorOne day while walking through a big box store, a customer was struck on the head by a flying bat (the mammal, not the wooden kind). He was concerned he might have contracted rabies from this contact and came to…

Melanoma

MelanomaThe most serious form of skin cancer.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewEver been worried about a new mole or discoloration appearing on your skin? Welcome to melanoma, the most serious form of skin cancer, which is increasing in people under 40. Almost 200,000 new cases of melanoma are estimated to be diagnosed in America this year…

Are you ready to start saving lives?