Treatment for a stress fracture of the calcaneus typically involves an initial period of rest, usually involving reduced weight bearing activity. Ct is the modality of choice to evaluate calcaneal fracture. Gradual increase in weight bearing in shoe starting at 20lbs. Calcaneal, or heel bone, fractures may occur due to prolonged overuse of traumatic injury. Stress fractures of the foot and ankle orthoinfo aaos. Management of a calcaneal nonunion and subtalar joint. Historically, these injuries have fared poorly with or without surgical intervention 1.
Management differs considerably based on fracture location and. Read this lesson to learn the difference between stress and avulsion fractures and how they are typically. Calcaneal stress fracturecausessymptomstreatmentheel. Computed tomography is rarely performed obtained in calcaneal stress fractures. Talus fracture 3 1 33% phalangeal fractures 11 6 55% metatarsal fracture 1 to 4 28 19 68% 5thmetatarsal fracture 33 22 67% mid foot soft tissue injuries 6 0 0 calcaneal fractures 5 0 0 nail bed injuries 1 1 100% stress fracture metatarsal 1 0 0 table 2. Stress fractures of the heel are uncommon in children. Stress fractures are common overuse injuries, and a calcaneus stress fracture is especially common in a runner or running athlete. The optimal management of intraarticular calcaneal fractures is controversial. Due to the fractures relative obscurity, the optimal form of intervention. The anterior calcaneal process constitutes the proximal insertion of the bifurcated ligament 66.
The mechanism of injury can range from high energy trauma falls from height to low energy trauma sport. There is a strong consensus for nonoperative treatment of calcaneal stress fractures, and indeed the only report in the literature of surgical repair is that of a 67yearold woman who sustained displaced fractures of both calcaneal tuberosities during a 3week hiking trek. Fiftysix percent of calcaneal stress fractures occur within the. Prevention and management of calcaneal apophysitis in children.
The specific treatment of these injuries varies with the location of the stress fracture and. Treatment for calcaneal stress reaction barefoot runners. These fractures sometimes result in longterm complications, such as chronic pain and swelling. The goals of operative management of a calcaneal fracture include. Delayed static images show an intense increase in tracer uptake localized to the posterior aspect of the right calcaneum highly suspicious of a fracture. Stress fracture rehabilitation guideline sanford health. Stress fractures of the foot and ankle in athletes ncbi nih. By squeezing the calcaneus from side to side, it is more likely to feel pain if you have calcaneal stress fracture. Most stress fractures are caused by overuse and repetitive activity, and are common in runners and athletes who participate in running sports, such as soccer and basketball. This may include the use of crutches or a protective boot. Im interested in understanding whether one typically is prescribed no weightbearing for a calcaneal. The management pathway for these calcaneal fractures is distinctly different than for other morphologies. Calcaneus heel bone fractures typically occur during a highenergy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body.
Shortterm effects of manual therapy in patients after surgical fixation of. Calcaneus fracture repair physical therapy protocol postop nwb on surgical foot elevate aggressively at heart level not above foot in posterior foot splint week 1. The fracture of this process occurs in 5% of patients with ankle fracture 7173. Pain from a stress fracture is typically limited to the area directly over the injured bone and is not generalized over the whole foot. When a bone is subjected to a new stress, such as a new exercise routine, it may not be prepared for the increased workload, and as a result, may develop a stress fracture. Healing time of a stress fracture of the calcaneus. Calcaneal fracture management via a combination of approaches. Causes of calcaneal stress fracture include increased weight bearing e. An open calcaneal fracture, while uncommon, provides a unique opportunity to visualize the relationship of the superomedial fragment to the tuberosity and the surrounding anatomy. Often, the key to diagnosing a stress fracture is the patients report of pain in response to this pressure. Fractures of the calcaneus represent about 12% of all fractures and 60% of the tarsal bones fractures 15. Calcaneus fractures are rare but potentially debilitating injuries. Signs and symptoms typically a runner with a calcaneus stress fracture will complain of pain that initially starts after a certain amount of running but gets better with rest. Morphological variants of calcaneal fractures, including tonguetype calcaneus fractures and associated tuberosity fractures, represent a unique pattern of injury to the bone and soft tissue.
A common running injury mistaken for severe plantar fasciitis. Pdf the pathophysiology, diagnosis, and management of. In severe cases, walking may be enough to aggravate symptoms. Pdf a stress fracture is a partial or complete bone fracture that results from. Virtual fracture clinic in the management of foot and. Kihm, dpm management of intraarticular calcaneal fractures is complex, challenging, and evolving. Stress fractures have been reported to occur in the pubis, femoral neck, proximal part of the tibia, and fabella during the postoperative period following total knee or total hip arthroplasty. Open calcaneal fractures can be managed with an array of treatment techniques and result in a wide range of outcomes.
Pdf stress fractures of the foot and ankle in athletes. The severity and treatment of extraarticular fractures depend on their location and size. Stress fractures of the foot and ankle in athletes philip b. Due to the complexity of the ankle joint and surrounding anatomy, calcaneal fractures have a high rate of complications. In some cases, a fracture may also enter the subtalar joint in the foot. Calcaneus fracture repair physical therapy protocol pg 2 12 weeks progressive wb begins 12 week md visit. If the diagnosis is still doubtful, especially for elite and. The location of symptoms from a stress fracture also are fairly unique in most cases. In addition, advanced imaging tests are commonly required. It can show the extent and extra or intraarticular components of the fracture and hematoma along the sole of the foot mondor sign.
Mr imaging of stress fractures in foot and ankle epos. Stress fractures may occur with over use or repetitive use, such as running. However, to our knowledge, calcaneal stress fractures after total hip or total knee arthroplasty have not been reported in the englishlanguage literature. Pdf stress fractures of the foot and ankle are common injuries in athletes. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intraarticular and displaced, affecting primarily the subtalar joint. Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction soeur, 1975. Seventytwo percent of these fractures resulted from falls.
The talus acting as a wedge causes depression and widening of the calcaneal body. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. Treatment treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. Mechanisms that generate such a lesion are impaction forces or compression and extreme tensile forces 74. A stress fracture is, by definition, a breach of the mechanical integrity of a bone as a result of the application of abnormal and repetitive stress 11. This relationship predisposes fracture fragments to loss of reduction and malunion if the patient bears weight prematurely. The sustentaculum tali is a common site of avulsion due to the strength of the attached deltoid ligament.
Calcaneal stress fracture calcaneal fracture modified from batemam2. It is more likely to be plantar fasciitis if your pain is at the bottom of the foot. A microfracture that usually occurs in the heel is due to abnormal stress that has been placed upon it. Signs and symptoms of a calcaneus fracture patients with a calcaneus fracture typically experience a sudden onset of. This initial period of reduced weight bearing may occur for approximately 6 weeks. Double external fixation distraction with minimallyinvasive and percutaneous repair carl a. Magnetic reso nance imaging mri is the imaging reference stand. A calcaneal stress fracture is heel pain that doesnt warm up during the day. A stress fracture to the calcaneus may occur as a result of overuse often associated from a recent increase or high volume of running or marching activity. These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the resulting forces can lead to the trauma of fracture. Your doctor may order imaging tests to help confirm the diagnosis. Calcaneal fracture management via a combination of. Stress fractures of the calcaneus diagnosed by sonography. Similarly to the investigation of metatarsal stress fractures by banal et al, 5 we propose that plain radiography should be the first imaging study when a calcaneal stress fracture is suspected clinically, as it is very accessible, is inexpensive, and can eliminate other diagnoses.
Xray ankle, subtalar, forefoot, toe aarom gentle stretch and isometrics. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. Both fracture fragments were displaced substantially superiorly, compromising achilles tendon function. Diag nosing calcaneal stress fractures can be a complicaimerci a. In the military, the calcaneus and metatarsals were the most. Calcaneal stress fractures are caused by repetitive overload to the heel and most commonly occur immediately inferior. A calcaneal fracture is one of the most common tarsal bone fractures that could occur in the event of overuse injuries or a fall from a great height. A stress fracture is a partial or incomplete fracture caused by the accumulation of stress to a. Stress fractures, caused by overuse or mild injury. Fractures of the tarsal bones account for only about 2% of all adult fractures and only half of tarsal fractures are calcaneus fractures. This bone supports the lateral column of the foot and carries our entire body weight while walking, which is why, a fractured heel bone is.
Cerament placement for nonunion and arthrodesis management. Types of calcaneal fractures fractures of the calcaneus may or may not involve the subtalar and surrounding joints. The calcaneus is the greatest tarsal bone, and has the function of sustaining the body. To diagnose and evaluate a calcaneal fracture, the foot and ankle surgeon will ask questions about how the injury occurred, examine the affected foot and ankle, and order xrays. Stress fractures of the foot and ankle a stress fracture is a small crack in a bone, or severe bruising within a bone. The most common symptom is pain around the heel that. Any information contained in this pdf file is automatically generated from digital material.
Know the causes, symptoms, treatment heel pad, plaster cast, rehab. Healing time of two months or so until the pain has gone away. The calcaneus is the second most common location for stress fractures in the foot. Calcaneal pain can also result from gross trauma, arthritic, metabolic, and neoplastic dis ease. They are mentioned by shanks and kerley in their text 3, and watsonjones considers them in passing, quoting asal, who reported goo stress fractures from german army hospital records during world war ii, of which 0.
Calcaneus fracture repair physical therapy protocol. This guideline is intended to provide the treating clinician a frame of reference for rehabilitation. A fracture may cause the heel bone to widen and shorten. Case discussion typical radiographic and scintigraphic appearances of a calcaneal stress fracture in the classic location. Imaging plays a key role in the diagnosis and management of stress injuries. Calcaneal stress fractures can occur in any population of adults and even children and are common among active people, such as athletes, sports enthusiasts, and military personnel. Fractures of the calcaneus heel bone fractures acfas. Surgery is no longer justified for most intraarticular displaced fractures displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor.
These injuries, in terms of fractures, fall into three general categories. Calcaneal stress fracture usually occurs alone figure 4. Stable internal fixation should allow early motion to restore function. Patients with this condition typically experience a pain on either the inner or outer aspect of the heel bone that increases with impact activity such as marching, running, jumping or landing. The intense physical demands of dancing put dancers at high risk for numerous injuries to the foot and ankle. Management differs considerably based on fracture location and predisposing. It is likely that the number of diagnosed calcaneal stress fractures will rise among practitioners with an increased recognition of their possibility. Stress fractures of the calcaneus, sesamoids, and metatarsals. Other causes of plantar heel pain include calcaneal stress fractures progressively worsening pain after an increase in activity or change to a harder walking surface, nerve entrapment or neuroma.
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