There is nothing glamorous about the heel bone, known as the calcaneus, the heel’s Latin name.
Despite significant improvements in the diagnosis and treatment of calcaneus fractures during the last several decades, it may nonetheless be noted some heels heal easily and other heels are hell to heal.
Fundamentally, heel fractures generally occur in the setting of high-energy trauma and can result in complex fractures extending in three dimensions. CT scans, not plain X-rays, have become the standard for analyzing these fractures, which (predominately) may involve any of several joints of the calcaneus. Treatment has almost become a sub-specialty of orthopedics.
Heel fractures constitute about 2 percent of all fractures and are the most common of the seven tarsal bones of the ankle. They are sometimes known as Don Juan or lover’s fractures: A lover may jump from great heights while trying to escape a bedroom tryst. One example is forever burned into my memory. A young sailor chose a second-floor bedroom window to escape such a compromising situation. Exiting was the easy part, but, on landing, he broke both heels. Probably unknown to the treating orthopedists, he was returned with crutches and casts to an aircraft carrier about to sail. Carriers have elevators, but they move aircraft between flight deck and hanger bay, not personnel. Also, another not-so-minor detail, Navy ships have ladders not stairways. The consolidated laughter in the ship’s medical department shook all 70,000 tons of the USS Saratoga. Needless to say, the sailor was returned to shore.
Falls and the male gender are the most common factors in heel fractures. Landing on feet or heels also transmits impact forces axially, that is, up the leg (or legs) to the hip, pelvis and spine. Thus, there exists the potential for other injuries. While I hate medical horror stories, one example must serve: A neighbor and friend, while well up a ladder, experienced the unfortunate circumstance of the ladder sliding sideways. In the inevitable fall, one heel was fractured; it became a hell-to-heal heel. That he was a smoker didn’t help. Bone healing was delayed; surgery was required; skin decomposed; skin grafts were necessary; and more than two years elapsed.
Finally healed, he had low-back pain and continuing inability to work. Workers compensation insinuated he was malingering, until a hip replacement cured the “back pain.” To his credit, he quit smoking. Lingering high-blood pressure, 50 pounds of weight gain and depression were further obstacles, but, ultimately, he and his family construction business survived.
A final example serves to illustrate a simple heel fracture – not comminuted (shattered), not involving a calcaneal joint and not displaced. The patient arrived at the emergency room in the wee hours. His complications were “social.” Thirties in age and with no immediate family, he was brought from jail. Leaving nothing to chance and to prevent a potential lifelong problem, we woke an orthopedist to ensure a slam-dunk procedure.
www.alanfraserhouston.com. Dr. Fraser Houston is a retired ER physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.
