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

How to Help During a Mental Health Crisis

By: Chad Larkin, BIS, EMTEMT InstructorPrevalence and CausesRoughly 1 in 5 adults has a mental illness, making it one of the most common health concerns in the United States. While the vast majority of people with a mental health concern are able to manage their illness well with community support, therapy, and medication, others may…

EMT and Trailing Search Dogs

By Joanne Ewen, JD, EMT, DOT-IK-9 Dog HandlerRoss Butterfield, EMT, is an EMSRB Examiner with Allied Medical Training. Ross is also a K9 Handler of an awesome search and rescue (SAR) dog called Bosco. He brought his enthusiasm for K9 Search and Rescue with him to AMT and recruited me to the Northstar SAR Team.…

Did you get your flu vaccination this year?

By Marven Ewen, MDMedical DirectorThe CDC recommends yearly immunization for influenza for all persons 6 months of age and older. Unfortunately, not everyone chooses to be immunized. As a result, people needlessly get ill, and in some cases, die. The fact that many people don’t get immunized makes it even more important that EMTs do.…

Search and Rescue Dogs

By: Joanne Ewen, JD, EMT, DOT-I, K9 HandlerThere are several kinds of search disciplines for K9s and their handlers, and this article discusses the two basic disciplines of all search dogs: trailing and area search. Northstar SAR has dogs and handlers trained in many SAR disciplines.Trailing dogs use a scented article from the missing person…

Understanding Deep Vein Thrombosis and Pulmonary Embolism

By: Marven Ewen, MD, Medical DirectorDeep Vein Thrombophlebitis, or DVT as it is usually referred to, is a common condition. Because of this, it is something that should be considered in any patient with an extremity complaint of pain or swelling, or in a patient with chest symptoms. The most common site is the deep…

K9s and EMTs Working Together

By Joanne Ewen, JD, EMT, DOT-IK9 HandlerNorthstar Search and Rescue ( is one of the leading K9 search and rescue organizations in Minnesota. I just became a member of it with my German Shepherd pup Coda, now 5 months old and absolutely loving the fun “game” of finding people in the woods and through high…


Are you ready to start saving lives?