Fracture of the Heel Bone (Calcaneus)

What it is
Fractures of the heel bone, or calcaneus, can be disabling injuries. They most often occur during high-energy collisions — such as a fall from height or a motor vehicle crash. Because of this, calcaneus fractures are often severe and may result in long-term problems. The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures. The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus. Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces.

Cause
The calcaneus can be injured in a fall, twisting injury, or motor vehicle collision. A simple twisting injury may result in the calcaneus being cracked. The force of a head-on car collision may result in the bone being shattered (comminuted fracture). Different causes can result in similar fracture patterns. For example, when landing on your feet from a fall, your body’s weight is directed downward. It drives the talus bone down into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus. In both cases, the resulting fracture patterns are similar. The greater the impact, the more the calcaneus is damaged.

Symptoms
The most common symptoms of a calcaneus fracture are:

Pain

Bruising

Swelling

Heel deformity

Inability to put weight on the heel or walk

In some minor calcaneus fractures, the pain is not enough to stop you from walking, but you may limp. This is because when you walk, the Achilles tendon acts through the calcaneus to support your body weight. If the calcaneus is deformed following an injury, the muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.