Broken heel bone

This article describes the causes, characteristics and treatment of a broken heel bone, i.e. a fracture in the hindfoot. The heel bone (calcaneus) is the bone that forms the heel of the foot. When standing or walking this bone bears a large part of the body weight.

The foot consists of no fewer than 28 bones. From the ankle there are first the tarsal bones including the talus and heel bone, then the metatarsal bones and finally the toes.

There are also articles with more information about a broken toe and a broken metatarsal.

How does a broken heel bone occur?

In most cases a fracture of the heel bone is a direct result of a hard landing on the heel during a fall or when jumping. Sports such as long jump or gymnastics therefore increase the risk of a fracture of the heel bone. The fracture also regularly occurs in people who land hard when parachuting.

The heel bone can also break due to a large pulling force of the Achilles tendon, which attaches to this bone. This is called an avulsion fracture. With an avulsion fracture the tendon pulls off a piece of bone. This usually happens when the calf muscles contract powerfully, but is very rare.

Characteristics (symptoms) of a broken heel bone

The main characteristic of a broken heel bone is a sudden, stabbing pain. This pain is often so severe that bearing weight on the heel and walking is impossible. Other characteristics are swelling and discolouration of the skin around the heel.

In severe fractures the heel of the foot is deformed and there can even be an open fracture. In an open fracture the skin is broken and a wound is visible.

If broken bone fragments shift, this can pinch a nerve. This is one of the causes of the tarsal tunnel syndrome. This is characterised by pain, numbness and tingling on the inside of the ankle.

How is a broken heel bone diagnosed?

A fracture of the heel bone is often already established after an interview with the patient and a physical examination. Touching the heel bone and movements of the ankle and foot will make the pain worse.

To be sure that the heel bone is broken, an X-ray is taken. This X-ray also provides more information about the severity and location of the fracture. When an X-ray does not provide sufficient clarity, a CT scan follows. This creates a 3D image of the foot. The fracture can then be viewed well from all sides.

Treatment of a broken heel bone

With a broken heel bone an operation may be necessary to repair the bone fragments. The surgeon will determine this after seeing the images and/or scans. If bone fragments have shifted, they must be placed back in the correct position. In that case an osteosynthesis is performed. The surgeon uses plates and screws that hold the bone fragments together. The lower leg and foot are then put in a plaster cast.

Even if no operation is necessary, the foot goes into plaster or a splint for six to eight weeks. The foot may not be loaded during this period. In addition, it is sensible to keep the foot elevated as much as possible to reduce the swelling. This also reduces the pain.

After the cast period the ankle will feel quite stiff. It is important to make the joints supple again and to build up muscle strength. The physiotherapist is the ideal person to guide this recovery. Largely through exercises and mobilisations.