Calcaneus Fracture Fixation

Overview

The calcaneus is your heel bone, the largest bone in your foot and the one that carries your full body weight with every step. Most calcaneus fractures happen from a hard vertical impact, almost always a fall from height where you land on your heels. The shock travels straight up through the bone and often drives a piece of it into the joint right above (the subtalar joint, where your heel meets the talus).

Surgery is considered when the fracture has shifted into the joint surface, when the heel has lost significant height, or when the bone has spread wide enough that your foot will not fit in a shoe. The goal of surgery is to put the joint surface back together cleanly and restore the heel's original shape: both matter for how your foot loads and how shoes fit.

Why it's done

Calcaneus fracture fixation is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common reasons include:

A break into the joint surface that has shifted
An uneven ridge in the joint surface speeds up arthritis in the joint just below the ankle.
Loss of heel height
A shortened heel changes how your ankle moves and makes shoes difficult to fit.
A heel that has spread too wide
A heel that has spread too wide can press against the tendons and the bone on the outer ankle.
A break pressing on the skin
Certain breaks push a piece of bone up against the skin from inside and need to be set quickly to protect it.

How it works

The traditional repair uses a longer incision on the outer side of the heel, with a plate shaped to fit the heel bone and several screws, once the soft tissue has rested and the swelling has come down. This gives the best view of the joint surface being rebuilt.

In selected fracture patterns, a smaller incision over the outer foot, with screws placed through small punctures in the skin, is used instead to reduce wound problems. Live X-ray in the operating room (fluoroscopy) and a direct look confirm that the joint surface below the ankle is smooth and the heel's overall shape is restored.

Recovery

After surgery your foot goes into a splint, then a boot. You will keep weight off it during the early healing phase because the heel bone carries your full weight with every step. Even a small amount of load early on can shift the repair before the bone has knit. Once the wound is healed, range-of-motion exercises for the ankle and the subtalar joint (the joint just below the ankle where your heel pivots) begin. Weight-bearing progresses gradually as bone consolidates. Even with a good repair, arthritis in the subtalar joint can develop over time; if that happens, a fusion of that joint may be discussed later. The hardware is left in place unless it becomes uncomfortable; it rarely needs to come out.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.

Physicians Who Perform Calcaneus Fracture Fixation

Michael S. Vrana, M.D.

David B. Templin, M.D.

Trent Twitero, M.D.

Weight-Bearing After Repair

A controlled amount of weight is part of how bone heals. Once the fracture is held in place with hardware, gentle weight through the leg helps the bone heal, and keeping all weight off a fixed fracture for too long can actually slow healing and stiffen the joints above and below. Putting your full weight on it right away, though, can be too much before the bone has caught up. The right answer sits in between: a partial weight-bearing plan your surgeon sets based on your fracture pattern, how strong the fixation is, your bone quality, and how the repair looks on X-rays after surgery. We tell you exactly how much weight the leg can take, when to add more, and what to watch for.

Risks & Why We Still Recommend It

Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a wide, short heel with a collapsed joint surface, chronic pain below the ankle, and a shoe that no longer fits. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.

The risks we discuss with you before calcaneus fracture fixation include:

bleeding and infection (the calcaneus has a thin, fragile soft-tissue envelope, wound complications are the defining risk of this operation)
anesthesia risk
irritation of a small nerve along the outer foot
blood clot in the leg or lung
stiffness and eventual arthritis in the joint below the ankle
hardware irritation
the bone failing to heal (uncommon)

Surgery is right when a heel-bone fracture has shifted into the joint surface and the skin and soft tissues can tolerate the incision. If that picture does not fit you, this operation is not offered.

Frequently Asked

questions we hear in clinic

Why does the surgery sometimes wait days after the injury?

The traditional approach is done once the soft tissue has rested and the swelling has come down. The calcaneus has a thin, fragile soft-tissue envelope, and wound complications are the defining risk of this operation, so the skin has to be ready before it is opened.

When can I walk on the foot?

You will keep weight off it during the early healing phase, because the heel carries your full body weight and even a small load early on can shift the repair before the bone has knit. Weight-bearing then progresses gradually on a plan your surgeon sets from your fracture pattern, the strength of the fixation, your bone quality, and post-op imaging.

Does the hardware come out later?

The hardware is left in place unless it becomes uncomfortable; it rarely needs to come out.

Will I get arthritis anyway?

Even with a good repair, arthritis in the subtalar joint can develop over time. If that happens, a fusion of that joint may be discussed later.

What happens if the fracture is not fixed?

Left untreated, this injury leaves a wide, short heel with a collapsed joint surface, which produces chronic pain below the ankle and a shoe that does not fit. That trade-off is why we recommend fixation when the fracture has shifted into the joint.