How is a calcaneal fracture treated?

How Is a Calcaneal Fracture Treated?

A calcaneal fracture is a complex injury involving the heel bone, most commonly caused by high-energy trauma such as falls from height or motor vehicle accidents. Because the calcaneus plays a central role in weight-bearing, shock absorption, and gait mechanics, treatment strategies must address both anatomical restoration and long-term functional recovery.

Effective management of calcaneal fractures requires a comprehensive understanding of fracture patterns, soft-tissue conditions, and patient-specific functional demands.

Understanding Calcaneal Fractures and Core Treatment Principles

The calcaneus is the largest tarsal bone and forms the foundation of the hindfoot. Fractures of this bone often disrupt normal foot biomechanics, leading to pain, deformity, and impaired mobility if not treated appropriately.

The primary goals of treatment include restoring calcaneal height, width, and alignment, maintaining joint congruity, and minimizing long-term complications such as stiffness or post-traumatic arthritis. Treatment decisions are guided not only by radiographic findings but also by soft-tissue status and patient expectations.

Calcaneal Fracture Classification and Its Influence on Treatment Strategy

Calcaneal fractures are commonly categorized into intra-articular and extra-articular types. This distinction is critical, as it directly influences treatment planning and prognosis.

Intra-articular fractures involve the subtalar joint and represent the majority of cases. These injuries are more likely to result in joint incongruity and long-term functional limitations if anatomical reduction is not achieved. Extra-articular fractures, by contrast, spare the joint surface and often have a more favorable prognosis.

Intra-Articular Fractures and Clinical Decision-Making

Management of intra-articular calcaneal fractures depends on factors such as fracture displacement, articular surface collapse, overall alignment, and patient activity level. Advanced imaging is frequently used to assess joint involvement and guide treatment selection.

Non-Surgical Management of Calcaneal Fractures

Non-operative treatment is generally reserved for fractures without significant displacement, extra-articular injury patterns, or patients for whom surgery poses an unacceptable risk.

Conservative management focuses on protecting the fracture while preserving joint motion and preventing secondary complications.

Immobilization and Functional Rehabilitation in Conservative Care

Initial treatment typically includes immobilization using a cast or walking boot, strict non-weight-bearing protocols, and elevation to control swelling. Once soft-tissue conditions improve, early range-of-motion exercises are encouraged to reduce stiffness and promote functional recovery.

Surgical Treatment Options for Displaced Calcaneal Fractures

Surgical intervention is considered when fractures demonstrate significant displacement, joint incongruity, or deformity that compromises foot mechanics. The timing of surgery is carefully planned to allow soft-tissue swelling to subside, reducing the risk of wound complications.

The primary objective of surgery is to restore anatomical alignment and joint surface congruity while preserving surrounding soft tissues.

Open Reduction and Internal Fixation for Calcaneal Fractures

Open reduction and internal fixation remains a widely used approach for displaced intra-articular fractures. This technique allows direct visualization of the fracture and precise restoration of the subtalar joint surface, contributing to improved functional outcomes when performed under appropriate conditions.

Minimally Invasive Fixation Techniques and Their Indications

Minimally invasive fixation techniques have gained popularity in selected cases. These approaches aim to reduce soft-tissue trauma while achieving acceptable fracture reduction, particularly in fractures with less comminution or favorable morphology.

Postoperative Management and Rehabilitation After Calcaneal Fracture Surgery

Postoperative care plays a decisive role in determining long-term outcomes. Structured rehabilitation protocols are essential to restore strength, mobility, and gait mechanics.

Early controlled motion helps prevent joint stiffness, while carefully staged weight-bearing supports fracture healing and functional recovery.

Weight-Bearing Progression and Functional Recovery Timeline

Partial weight-bearing is typically introduced between eight and ten weeks following surgery, depending on radiographic evidence of healing. Full weight-bearing is gradually resumed once sufficient fracture consolidation is confirmed, often requiring several months of rehabilitation.

Long-Term Outcomes and Potential Complications of Calcaneal Fractures

Despite appropriate treatment, calcaneal fractures may lead to long-term complications such as subtalar stiffness, chronic heel pain, or post-traumatic arthritis. These risks are higher in severe intra-articular fractures and cases with residual joint incongruity.

Long-term outcomes depend on fracture severity, treatment quality, and adherence to rehabilitation protocols.

Selecting the Most Appropriate Treatment Approach

There is no universally optimal treatment for all calcaneal fractures. Successful outcomes rely on individualized treatment planning that balances fracture characteristics, patient functional demands, and available surgical expertise.

Shared decision-making between the treating surgeon and patient is essential to align clinical goals with realistic expectations.

Frequently Asked Questions About Calcaneal Fracture Treatment

Can all calcaneal fractures be treated without surgery?

Not all calcaneal fractures are suitable for conservative treatment. Displaced fractures involving the subtalar joint often require surgical intervention to restore anatomy and function.

How long does recovery take after a calcaneal fracture?

Recovery typically ranges from six to twelve months, depending on fracture type, treatment method, and rehabilitation progress.

Will a calcaneal fracture cause permanent functional limitations?

Many patients regain the ability to walk and perform daily activities, although severe intra-articular fractures may result in residual stiffness or pain.

When is surgery strongly recommended for calcaneal fractures?

Surgery is generally recommended when fractures cause significant joint surface disruption, loss of alignment, or functional instability.

Is post-traumatic arthritis common after calcaneal fractures?

Post-traumatic arthritis is relatively common following intra-articular calcaneal fractures, particularly when anatomical reduction is incomplete.