Ask Dr. Anderson: Could I Have a Heel Fracture?
Your heel pain could flag a heel fracture requiring expert evaluation and treatment.
We don’t realize how much we depend on our heels until they hurt. Is a painful heel an indication of a heel fracture? As it turns out, diagnosing heel pain can be a complex matter requiring specialized expertise. Foot and ankle specialist and surgeon Dr. Michael Anderson discusses heel fractures and explains why prompt medical evaluation is important.
How does a heel fracture occur?
The heel can be fractured in a wide variety of ways. “Most heel bone, or calcaneus, fractures are the result of high-energy trauma,” notes Dr. Anderson. “Because they are the result of significant force, these injuries can affect the entire heel joint. That’s why we refer to them as intra-articular joint fractures: fractures within the joint. These more severe heel injuries are the result of high-energy impacts like a car crash, a fall from a roof or ladder, or another high-velocity accident. Keep in mind, a heel fracture can also happen as the result of sporting accidents, but these are less frequent. And a sports-related heel fracture tends to be less severe than fractures caused by high-impact trauma.”
“I do not envy people who suffer a serious break of their heel bone,” says Dr. Anderson. “These can be complicated injuries. Any time you break into a joint, the repair is going to be challenging. When the heel bone is shattered, it can be a life-altering. Most people are left with some degree of stiffness, swelling, and probably discomfort in the injured ankle. In addition, intra-articular joint injuries increase the risk of developing arthritis in the joint.”
Heel fracture symptoms
“It’s difficult to offer a definitive list of symptoms because there are many different ways to fracture the calcaneus bone,” he explains. “Severe calcaneus fractures are going to hurt—a lot. There will be significant pain and swelling. In fact, the swelling can be so bad that the skin around the fracture blisters. Generally speaking, if you break your heel bone, it’s going to be apparent that something is wrong. People usually go immediately to the emergency room for treatment—as they should.”
Will this injury heal by itself without treatment?
“A heel fracture will heal on its own,” admits Dr. Anderson. “However, without medical treatment, the concern is whether these fractures will heal in the best position to minimize a potentially poor outcome. At worst, a heel fracture mends improperly. That’s a really tough problem, because we have to rebreak and realign the injured bone. This is something you want to avoid. That’s why I always advise people to have heel pain promptly evaluated by an orthopedic foot and ankle specialist. Not everyone needs surgery, but you do need an expert to correctly diagnose your injury, determine appropriate treatment, and monitor your recuperation.”
Several types of heel fractures
“The variety of potential heel injuries is what makes them so tricky to treat,” Dr. Anderson explains. “And because these fractures are located in a joint, they can be more complex to evaluate. That’s why you want to see a foot and ankle specialist. Fellowship training in foot and ankle gives us hands-on treatment of hundreds of complicated foot injuries, knowledge of the diagnostic nuances, and deep experience developing a personalized treatment plan to maximize your outcome.”
- Intra-articular joint fractures. The high-energy calcaneus fractures affecting the joint are the most common. However, they are only one type of heel fracture.
- Stress fractures. This heel injury is usually the result of overuse. “If a runner complains of lingering or worsening heel pain, I check for a stress fracture,” says Dr. Anderson. “Stress fractures don’t need surgery, but they do need medical management. We can heal them with rest and a period of avoiding repetitive impact. But recovery depends on which bone in the joint is affected. Some take longer to heal than others.”
- Avulsion fractures of the Achilles tendon. “There are cases where the Achilles tendon stretches or tears, pulling off a piece of heel bone,” explains Dr. Anderson. “An avulsion describes the condition where a bone piece breaks off at a corner of the bone structure. This is a completely different kind of injury than a high-impact fracture. Generally speaking, all avulsion fractures require surgery. Fortunately, treatment outcomes for this fracture injury are good. Unlike intra-articular fractures, these tend to do well, with lower risks for developing arthritis over time.”
- Avulsions of the anterior process. “These fractures are the result of a serious ankle sprain that causes a corner of heel bone to break off,” says Dr. Anderson. “Avulsions of the anterior process sometimes do well without surgery. However, if the bone fragment is large enough, we recommend a surgical repair.”
Prompt medical evaluation improves fracture outcomes
“There are many different ways you can break your calcaneus,” concludes Dr. Anderson. “For each type of fracture, there are a variety of treatment options. You could find yourself walking in a boot to support bone healing. Or you may need surgery and be required to stay off your heel for several months. My objective is to maximize your recovery. That starts with an accurate diagnosis. Then, we’ll decide together about the most effective treatment for your circumstances, so your injury heals in the best way possible.”
Summit Orthopedics offers personalized foot and ankle expertise
Our fellowship-trained foot and ankle physicians understand that your mobility depends on the health of your feet and ankles. If you have suffered an injury or are experiencing symptoms that make walking painful, our team of foot and ankle specialists can help with conservative treatment; proven, evidence-based surgical options; and expert rehabilitation support. Summit Orthopedics specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely get you back on your feet and on your way.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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