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

Dealing with Stress

by Jennifer EwenStress is an inevitable part about being both a student and a healthcare professional. It’s very important to be able to cope with stress in order to perform well in both your professional and personal life. Here are five ways to manage your stress so you can do your best work possible, both…

EMS Test Taking Strategies

By Sean Ewen, MDProgram DirectorStudents who are new to the health field often experience difficulty with the application style multiple choice questions encountered in their exams and on the NREMT certification exam. These questions typically involve several layers of knowledge recall combined with using your best judgment to answer the question. Often, the answer choices…

Memorization and Study Tips

By Jennifer EwenOne of the most important part of studying for the NREMT certification and psychomotor practical skills exams is memorization. EMT students are faced with a lot of facts and procedures that they need to memorize in order to be successful in the course. When you start studying, first you need to know what…

Planning Ahead for Weather

By Greg Johnston, EMTInstructor and retired military-trained cold weather, water search and rescue diverWelcome all current and prospective EMS professionals. It’s that time of year again when we need to start preparing for another season of cold stretches and long shifts. As none of us are getting any younger, we need to make sure our…

Understanding Emergency Cardiac Medications

By Marven Ewen, MDMedical DirectorEMTs have several medications they can use to initiate treatment of various emergency medical conditions. It’s important the EMT understands basics of the pharmacology of these interventions. When you understand how something works, as opposed to just memorizing it, you are more likely to remember the indications, contraindications and potential side…

Are you ready to start saving lives?