Therapy of a broken heel bone

General

The Heel bone is the greatest Tarsus and resembles the shape of a cuboid.
The calcaneus fracture is a typical fracture due to one hand Fall from a great height and on the other hand one vertical compression.

In the calcaneal fracture therapy, both conservative as well as operational Measures to choose from, which are chosen depending on the type of fracture. There are roughly three different types of heel bone fractures: the "duck bill fracture", in which part of the heel bone breaks off due to excessive pulling of the Achilles tendon, "joint depression", which is more of a kind of impression fracture, and the "tongue type", in which the The fracture line runs almost horizontally through the calcaneus.

Symptoms

Typical symptoms of a broken heel bone are Pain in the Heel area and a noticeable swelling.
The Soft tissue swelling on the heel can even lead to the part of the foot widening significantly, making the shoes no longer fit. That too Arch of the foot can be flattened.
The result of the pain is often a functional impairment insofar as there is no impact on the heel and no mobility of the Ankle possible are.
As a result of the bone fracture, there is usually an additional formation Hematoma on the heel. Accompanying injuries are also not to be neglected.

root cause

One type of heel fracture can result from direct exposure to violence or just through Twist develop.

However, the typical course of accidents or injury mechanisms are directly related to axial forces. These arise, for example, when you fall or jump from a great height, or even when you fall car accidentwhen you hit an obstacle head-on and your heel is compressed. What kind of calcaneus fracture occurs depends on the person Foot posture at the moment of compression.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

diagnosis

A calcaneus fracture can be diagnosed using various methods.

On the one hand, the course of the accident usually indicates this, for example if there is a axial Upsetting or a fall from a great height. In addition, the suspicion is reinforced by the fact that the Heel hurts and not burdened can be.

A good imaging measure to secure the diagnosis and for precise localization is a conventional one X-ray of the calcaneus in two planes. Here, for example, there would be cracks in the heel bone fracture bone or Step formation to recognize. In addition, it is important for the treatment method to know whether the calcaneus fracture is dislocated, i.e. whether individual fragments are displaced or not.

When a surgery is necessary to treat the fracture, a Computed Tomography to get a better impression of the fracture lines and fragments to be treated and especially of the severity of the fracture.

Therapy of a broken heel bone

As is so often the case with the Therapy of the calcaneus fracture the choice between one conservative and one operative treatment.

What you choose depends on at least two factors. First and foremost is the question of whether there is a dislocated fracture, i.e. one in which bone fragments are displaced, is or not. Second, we are interested in the state of the surrounding soft tissues and their Blood circulation.

In the case of a fracture of the heel bone that is not or only slightly dislocated, one often opts for one conservative therapy. It would also be the first choice in the event of a rubble break. In addition, the blood circulation and soft tissue situation are more likely to be classified as critical, which is also a reason for conservative treatment.
This usually looks like the heel for about six weeks is relieved and protected in a special rail. Therapy can take place with Painkillers and physiotherapy get supported.
Following the discharge phase will radiographically the Heel bone controlled. If the X-ray control shows good and timely healing progress, the calcaneus can gradually return more burdened become.
If necessary afterwards, you can Shoe insoles be prescribed, which further protect the heel bone and possible Misaligned feet should compensate.

Everyone dislocated and open calcaneal fracture should be used in uncritical soft tissue situations operational be treated. It is always an advantage if the break is made only few fragments exists so that they can be better fixed in the original position.
If the calcaneus fracture still consists of several pieces of debris, a closed reduction can be performed with special wires that are inserted from the outside Broken bone stabilize. Roughly speaking, the bone fragments are threaded so that the resulting fixation corresponds to the original shape of the calcaneus. Inaccuracies on the joint surface cannot always be prevented.
But come in comparison to open surgery Soft tissue infections and even complicated debris fractures can be effectively stabilized.
As an alternative to closed reduction of the calcaneus fracture is the open surgery. This usually consists of a reduction of the fracture fragments into the original location and the Fixation with either screws, a tension cord, or a plate.
Particularly careful handling of the surrounding soft tissue is to be emphasized in order to avoid a postoperative Wound healing disorder to avoid through circulation problems and too large soft tissue defects. In addition, infections of the wound should be avoided as far as possible or treated immediately in order not to endanger the success of the surgical treatment and to keep the spread of the soft tissue defect as small as possible.

The procedure for a so-called "Broken duckbill" of the calcaneus is often after correction of the bone shape this with certain Cancellous screws fixed so that the Achilles tendon, which in this case is anchored to the broken bone part, can no longer mobilize it. As an alternative to the cancellous screw, a Tension cord wirewhich can be inserted through pre-drilled holes in the tear-off fragment and in the heel bone, can be used for fixation. For the surgical treatment of the other forms of Heel fracture, especially that of the impression fractures, surgery with open correction of the bone shape and fixation with a plate are often used.
When inserting the plate should be meticulous on the course of the resident annoy and Vessels Be careful not to injure them. You usually work your way from the inside of the break outwards. Additional wires and screws can be used to hold the bone parts in the correct position.

Usually on End of the operation a drainage inserted so about it Wound fluid can expire. However, this can usually be removed relatively early. Otherwise apply to the follow-up treatment of a surgical procedure Calcaneal fracture protecting the heel for about four to six weeks and wearing one Walking iron to relieve the heel bone.
In addition, physiotherapy can be prescribed to restore mobility. If the fracture of the calcaneus heals properly and without complications, it can slowly be subjected to more stress after the rest.

forecast

The forecast depends on Severity of Heel fracture and their treatment.

The surgical methods have slight advantages, but this does not generally apply to all types of calcaneal fractures. It should not be neglected that due to the injury and an operation the joint between the talus and heel bone increases the risk of developing a arthrosis is very high.

prophylaxis

There a Calcaneal fracture Classically arises in connection with an accident or direct application of force, there is little prophylaxis here.
You can only try afterwards not to put too much strain on the heel bone and to take good care of the wound so that everything can heal completely again. Special physiotherapy can also help a possible post-traumatic event arthrosis to prevent in the joint between the talus and heel bone.