Today, 4% of all types of bone damage are fractures of the calcaneus. This pathology is a violation of the integrity of the calcaneus, when it is impossible to apply the standard treatment option. In trauma, a wide variety of injuries of a different nature can be observed, which complicates their classification. This phenomenon is not common in modern medicine. Typically, injury occurs as a result of a fall from a height, and a great deal of force is needed to damage the bone. Therefore, such fractures are most often encountered, the healing of which occurs in a short period of time. But sometimes a fracture is a serious injury that can cause serious complications.
Pathology Description
Fractures of the calcaneus are a violation of the integrity of the largest and strongest bone of the foot, localized in the tendons. Such a pathology is observed in half of all cases of foot injuries, it helps to limit the person’s independent movement.
The heel bone is involved in the walking of a person, producing a supporting and depreciation function. She takes on all the weight of a person when walking. The heel consists of their cancellous bone, which is located in the tendons, blood vessels are located around it.
In most cases, a unilateral fracture occurs, rarely - multiple injuries, accompanied by damage to the ankle, and in some cases the spine. Most often, athletes who engage in active sports are injured.
Note! In 85% of cases, a fracture of a leg, heel bone fracture is observed as a result of a fall from a height and landing on straightened legs. Sometimes the injury is formed when squeezing the legs or when striking the heel.
The degree of development of pathology
Heel fracture has the following severity levels:
- Easy. In this case, a bone fracture without displacement is observed.
- The average is due to the displacement of the fragments without injuring the joints.
- Severe is characterized by displacement of debris and trauma to the joints.
Calcaneus fractures: classification
Based on how the foot is located upon impact, and also on the height of the fall, the following types of injuries are distinguished:
- A marginal fracture that resembles a duck beak.
- An extra-articular fracture is divided into damage to the body of the bone and trauma to the tuber of the heel bone.
- Intra-articular fracture is observed in 20% of cases. It can occur both along and across the bone. Based on this, horizontal and vertical intraarticular fractures are distinguished.
- Compression, when the bone is compressed and split into several parts.
- Isolated, which is limited to one bone.
- Fatigue fractures occur with regular physical activity on the heel. Typically, such injuries occur in soldiers and athletes.
- Calcaneal fracture with displacement often occurs in road accidents. There is a strong heel shift relative to other bones.
The design of the fracture depends on the strength of the impact and the side of the limb to which it was applied. When falling on the heels, the bone breaks into two or more parts.
Reasons for the development of pathology
Calcaneal fractures result from the following causes:
- Fall from a height at which a fracture often occurs on both limbs.
- A blow of great strength to the heel or sole.
- Strong squeezing legs.
- Traffic accidents.
- Sports injuries.
- Diseases that lead to a decrease in bone density.
Symptoms of the disease
A fracture of the calcaneus shows signs in the form of a strong pain syndrome, the inability to move independently. With a closed fracture, a bone change occurs, the heel area expands, the foot begins to swell, and a hematoma appears.
Note! A closed calcaneal fracture without displacement is considered dangerous, because often a person does not understand what happened, therefore does not go to the clinic, which increases the risk of serious complications.
With an open fracture, the tissues are severely damaged, bleeding appears, fragments of broken bones can be found in the wound, and a strong pain syndrome develops. Typically, the symptoms of an open fracture are bright, so a person immediately goes to the hospital.
With heel injury, which is complemented by a fracture of the spine, ankle or hip, a more vivid picture of the pathology occurs, which makes it difficult to make a correct diagnosis.
If the diagnosis is incorrectly made, abnormal bone fusion occurs, which leads to complex surgery in the future, which ends with a person’s disability. Such outcomes are caused by the formation of flat feet, a change in the shape of the foot, the development of arthrosis, osteoporosis, and changes in soft tissues.
Diagnostic measures
When a person broke his heel, it is imperative to contact a medical institution. Diagnostics is performed by a traumatologist. First, he studies the history of the disease, conducts a conversation with the patient, finding out the presence of concomitant diseases and injuries. Then the traumatologist examines the damaged leg, during which it determines the swelling and hematoma in the damaged area. A fracture of the calcaneus with a shift will be accompanied by a change in the shape of the heel and a characteristic crunch of fragments. With an open fracture, attention is paid to damage to the skin and muscles.
Then the doctor prescribes a radiography, which acts as the main diagnostic technique. X-rays are performed in several projections, which makes it possible to identify the location of the fracture, to establish the presence of fragments and bone displacement. When conducting an x-ray, the doctor draws attention to a change in the Behler angle, which should normally be forty degrees. With fractures, it decreases, sometimes reaching negative values.
In severe cases, CT is prescribed. This method allows you to determine additional bone fragments, the nature of their displacement and the presence of small fragments.
Treatment methods
The main goal of therapy is foot reconstruction and restoration of limb motor activity. Calcaneal fracture treatment involves conservative or surgical. What methods are used in what cases? Treatment for calcaneus fracture depends on the degree of damage, the condition of the patient and his age.
For minor fractures, the following methods of conservative therapy are used:
- Fracture of the calcaneus without displacement requires a functional method in which the injured leg is fixed in an elevated position, while the patient is prescribed bed rest for up to fifteen days.
- Fracture of the heel with a slight displacement requires a closed reposition, after which the patient is given gypsum, which he will wear for up to six weeks. Plaster is applied from the toes to the knee joint, while a metal insole is pre-installed. Before applying the gypsum and after removing it, a radiography is performed.
- Fracture of the calcaneus with a shift involves treatment in the form of skeletal traction, which lasts about four weeks, after which the patient is given plaster for six weeks. Today, a bi-directional pull technique is used that is inserted into the heel bone. Stretching lasts up to six weeks, then put gypsum to the knee joint for up to three months.
An effective method of therapy is external transosseous compression osteosynthesis. Moreover, in each case, needles are used, which are installed in a characteristic direction. Such treatment makes it possible to correctly and stably fix the position of bone fragments, so that the patient has the opportunity to perform movements and loads on the injured limb earlier, as well as prevent the formation of flat feet and arthrosis of the joints.
None of the treatment methods today gives one hundred percent results of a full recovery, only sometimes positive outcomes can be achieved. In 80% of cases, the use of conservative medicine is not effective, many patients become disabled.
Surgical intervention
Operations are resorted to in severe cases when there is a complex fracture or inefficiency from conservative therapy. Immediate surgical intervention requires open fractures, operations are performed on the second day after limb damage. The doctor uses general or local anesthesia, treats the skin with antiseptics, and then makes an incision in the soft tissues. After that, he collects the debris, compares them and fixes with knitting needles or screws. With a large number of fragments, the Ilizarov apparatus is used. All operations are carried out under x-ray control.
With effective treatment, bone fusion occurs with the formation of bone marrow. To accelerate this process, a rehabilitation course is prescribed.
With intraarticular comminuted fractures of the heel, which are accompanied by severe pain syndrome, subtalar arthrodesis is prescribed. Before using this technique, the doctor must find out the cause of the development of the pain syndrome, as often the pain is formed due to compression of the tendons, which are displaced under the ankle. In this case, the removal of the tip of the outer ankle is performed. Arthrodesis makes it possible to stabilize a deformed foot and relieve pain.
Calcaneus fracture: rehabilitation
After treatment, it is very important to undergo a rehabilitation course, which can last up to two years, depending on the severity of the fracture. During this period, the doctor prescribes massage after a fracture of the heel, as well as exercise therapy, physical therapy and wearing special orthopedic shoes. The development of complications in the future depends on how the patient prescribes and recommends the doctor. Doctors say that the patient can begin a normal lifestyle in the absence of complications after three months.
Physical exercises include extension and flexion of the limb in the knee with a gradual increase in load. It is also recommended to unbend and bend the toes, this exercise is carried out on the third day after the appointment of exercise therapy. Also, as an exercise, you need to roll a simple can with your injured leg back and forth. This exercise allows you to stretch your limbs well. Together with exercise therapy, they massage the feet and lower legs.
Massage is the most effective rehabilitation method. After the fracture, it is carried out in the thigh area, which makes it possible to eliminate puffiness. After the plaster is removed, it is carried out on the lower leg and feet. Such a therapeutic measure is performed within two weeks after removal of the cast. Only a specialist should conduct it.
Exercise therapy includes simple exercises that the patient can perform at home. You can exercise on a stationary bike, walk more.
Complications
In the absence of timely treatment and rehabilitation, the risk of complications increases. Among them:
- Joint stiffness.
- Irritation of the joints, as well as the seam area, which is provoked by staples or knitting needles.
- Slow wound healing.
- Arthritis.
- Thrombosis.
- Chronic pain syndrome.
- Joining secondary infections.
- Collapse of bone tissue.
Forecast
The prognosis of the pathology can be favorable for simple injuries in case of timely therapy and compliance with all prescriptions of the physician. Typically, the disease can not be completely cured, often a fracture of the calcaneus manifests the consequences in the form of a person’s disability. In 80% of cases, displacement fracture therapy leads to unsatisfactory results. In almost half of cases, repeated surgical intervention is required three years after damage to the leg. A large percentage of complications after fracture therapy indicates the need for timely diagnosis and ideal anatomical reposition, proper phased management of the patient.
Prevention
In order to prevent, it is necessary to avoid injuries, to observe safety rules when playing sports. It is recommended to use orthopedic shoes or one that has a shock-absorbing sole that can protect the foot when jumping.
If it is necessary to land on legs from a great height, it is recommended to group, make the legs elastic. If the first symptoms of the fracture appear, you should immediately contact the clinic.
Finally ...
Today, the treatment of calcaneal fractures is a difficult task, which requires an ideal anatomical comparison of the bones, as well as their retention until complete healing. Often, damage leads to the development of contractures of the joints of the foot and lower leg, vascular disorders, osteoporosis, and so on. An improperly healed fracture often provokes the development of flat feet and arthrosis, which can cause a person's disability.
In medicine today, methods for the effective treatment of calcaneus fractures are not sufficiently developed, therefore, doctors often make mistakes both in the diagnosis and in the treatment of pathology. As a result of this, many people become disabled, whose quality of life is significantly impaired. Therefore, it is recommended to avoid traumatic situations, follow safety rules.