Today, 4% of all types of bone tissue damage are calcaneus fractures. This pathology is a violation of the integrity of the calcaneus, when it is impossible to apply the standard treatment option. In trauma, a wide variety of different types of damage can be observed, which makes it difficult to classify them. This phenomenon is rare in modern medicine. Usually, the injury occurs as a result of a fall from a height, and a large force is required to damage this bone. Therefore, most often there are such fractures, the healing of which occurs in a short period of time. But sometimes a fracture is a severe injury that can cause serious complications.
Description of pathology
Fractures of the calcaneus - violation of the integrity of the largest and strongest bone of the foot, localized in the tendons. This pathology is observed in half of all cases of foot injuries, it contributes to limiting the independent movement of a person.
The heel bone is involved in human walking, producing a supporting and shock-absorbing function. She takes all the weightperson while walking. The heel consists of spongy bone, which is located in the tendons, blood vessels are located around it.
In most cases, a unilateral fracture occurs, rarely - multiple injuries, accompanied by damage to the ankle, and in some cases, the spine. Most often, athletes who are involved in active sports are injured.
Pay attention! In 85% of cases, a fracture of the leg, calcaneus is observed as a result of a fall from a height and landing on straightened legs. Sometimes an injury occurs when the foot is squeezed or when a blow is struck to the heel.
Degrees of development of pathology
A heel fracture has the following severity:
- Easy. In this case, there is a fracture of the bone without displacement.
- Average is determined by the displacement of debris without injuring the joints.
- Severe is characterized by displacement of debris and trauma to the joints.
Fractures of the calcaneus: classification
Based on how the foot is located upon impact, as well as on the height of the fall, the following types of injuries are distinguished:
- A marginal fracture that looks like a duck's beak.
- Extra-articular fracture is divided into damage to the body of the bone and trauma to the tuber of the heel bone.
- Intra-articular fracture occurs in 20% of cases. It can occur both along and across the bone. Based on this, horizontal and vertical intra-articular fractures are distinguished.
- Compression, when the bone is compressed and split into several pieces.
- Isolated, which is limited to one bone.
- Fatigue fractures occur with regular physical stress on the heel. Usually such injuries occur in soldiers and athletes.
- Displaced calcaneus fractures are common in road accidents. Here there is a strong shift of the heel relative to other bones.
The design of the fracture depends on the force of impact and the side of the limb to which it was applied. When falling on the heels, the bone splits into two or more pieces.
Causes for the development of pathology
Fractures of the calcaneus appear as a result of the following reasons:
- Falling from a height, often resulting in fractures in both limbs.
- High force impact on the heel or sole.
- Strong squeezing of the leg.
- Road accidents.
- Sports injuries.
- Diseases that lead to a decrease in bone density.
Symptoms of the disease
Fracture of the calcaneus shows signs in the form of a strong pain syndrome, the inability to move independently. With a closed fracture, a change in the bone occurs, the heel area expands, the foot begins to swell, and a hematoma appears.
Pay attention! A closed fracture of the calcaneus without displacement is considered dangerous, because often a person does not understand what happened, so they do not go to the clinic, which increases the risk of developingserious complications.
With an open fracture, tissues are severely damaged, bleeding occurs, fragments of a broken bone can be found in the wound, and a strong pain syndrome develops. Usually, the symptoms of an open fracture are bright, so the person immediately goes to the hospital.
When a heel injury is accompanied by a fracture of the spine, ankle or hip, a more vivid picture of pathology appears, making it difficult to make a correct diagnosis.
If the diagnosis is wrong, the bones will not grow together correctly, which leads to a complex operation in the future, which ends with a person's disability. Such outcomes are determined by the formation of flat feet, changes in the shape of the foot, the development of arthrosis, osteoporosis, and changes in soft tissues.
Diagnostic measures
When a person has broken his heel, it is imperative to go to a medical facility. Diagnosis is carried out by a traumatologist. First, he studies the history of the disease, conducts a conversation with the patient, finding out the presence of concomitant diseases and injuries. Then the traumatologist examines the injured leg, during which he determines swelling and hematoma in the damaged area. A displaced fracture of the calcaneus will be accompanied by a change in the shape of the heel and a characteristic crunch of fragments. With an open fracture, attention is paid to damage to the skin and muscles.
Then the doctor prescribes an x-ray, which is the main diagnostic technique. X-rays are performed in several projections, which makes it possible to identify the location of the fracture, to establish the presence of fragments and displacement of the bone. When conducting an x-ray, the doctor pays attention to the change in the Beler angle, which should normally be equal to forty degrees. With fractures, it decreases, sometimes reaching negative values.
In severe cases, a CT scan is prescribed. This method allows you to determine additional bone fragments, the nature of their displacement and the presence of fragments of small size.
Treatment methods
The main goal of therapy is the reconstruction of the foot and the restoration of the motor activity of the limb. A fracture of the calcaneus is treated conservatively or surgically. What methods are used in what cases? Treatment for a calcaneal fracture depends on the extent of the injury, the condition of the patient, and their age.
For minor fractures, the following methods of conservative therapy are used:
- Fracture of the calcaneus without displacement requires a functional method in which the injured leg is fixed in an elevated position, while the patient is prescribed bed rest for up to fifteen days.
- A slightly displaced heel fracture requires a closed reduction, after which the patient is given a cast that will be worn for up to six weeks. Gypsum is applied from the toes to the knee joint, while a metal insole is preliminarily installed. X-rays are taken before the plaster is applied and after it is removed.
- Fracture of the calcaneal bone with displacement treatment suggests in the form of a skelet altraction, which lasts about four weeks, after which the patient is put in a cast for six weeks. Today, the technique of stretching in two directions behind the needle, which is inserted into the heel bone, is used. Traction lasts up to six weeks, then a cast is placed up to the knee joint for up to three months.
An effective method of therapy is external transosseous compression osteosynthesis. In this case, in each case, spokes are used that are installed in a characteristic direction. Such treatment makes it possible to correctly and stably fix the position of bone fragments, thanks to which the patient has the opportunity to perform movements and loads on the injured limb earlier, as well as to prevent the formation of flat feet and arthrosis of the joints.
None of the methods of treatment today does not give one hundred percent results of a complete recovery, only sometimes positive outcomes can be achieved. In 80% of cases, the use of conservative medicine is not effective, many patients become disabled.
Surgery
Surgeries are resorted to in severe cases, when there is a complex fracture or ineffectiveness from conservative therapy. Open fractures require immediate surgical intervention; operations are performed on the second day after the injury to the limb. The doctor uses general or local anesthesia, treats the skin with antiseptics, and then makes an incision in the soft tissues. After that, he collects the debris, collates them and fixes them.knitting needles or screws. With a large number of fragments, the Ilizarov apparatus is used. All operations are carried out under X-ray control.
With effective treatment, the bones grow together with the formation of callus. To speed up this process, a rehabilitation course is prescribed.
In case of intra-articular comminuted fractures of the heel, which are accompanied by severe pain, subtalar arthrodesis is prescribed. Before using this technique, the doctor must find out the cause of the development of the pain syndrome, since pain is often formed due to compression of the tendons that are displaced under the ankle. In this case, the top of the outer ankle is removed. Arthrodesis provides an opportunity to stabilize the deformed foot and relieve pain.
Fractured calcaneus: rehabilitation
It is very important to undergo a rehabilitation course after treatment, which can last up to two years, depending on the severity of the fracture. During this period, the doctor prescribes massage after a heel fracture, as well as exercise therapy, physiotherapy and wearing special orthopedic shoes. The development of complications in the future depends on how the patient will fulfill the appointments and recommendations of the doctor. Doctors say that the patient can start a normal lifestyle in the absence of complications after three months.
Physical exercises include extension and flexion of the limb at the knee with a gradual increase in load. It is also recommended to unbend and bend the toes, such an exercise is carried out on the third dayafter the appointment of exercise therapy. Also, as an exercise, you need to roll a simple jar with an injured leg back and forth. This exercise allows you to stretch the limb well. Together with exercise therapy, a foot and lower leg massage is performed.
Massage is the most effective method of rehabilitation. After a fracture, it is carried out in the thigh area, which makes it possible to eliminate puffiness. After the plaster is removed, it is carried out on the lower leg and feet. Such a therapeutic event is performed for two weeks after the removal of the plaster. Only a specialist should conduct it.
Exercise therapy includes simple exercises that the patient can perform at home. You can do an exercise bike, walk more.
Complications
In the absence of timely treatment and rehabilitation, the risk of complications increases. Among them:
- Joint stiffness.
- Irritation of the joints, as well as the seam area, which is provoked by staples or knitting needles.
- Slow wound healing.
- Arthritis.
- Thrombosis.
- Chronic pain syndrome.
- Accession of secondary infections.
- Bone collapse.
Forecast
Prognosis of pathology can be favorable for minor injuries in case of timely therapy and compliance with all medical prescriptions. Usually, the disease cannot be completely cured, often a fracture of the heel bones manifests the consequences in the form of a person's disability. In 80% of cases, the therapy of displaced fractures leads to unsatisfactory results. In almost half of the cases, repeatedsurgery three years after the leg injury. A large percentage of complications after fracture therapy indicates the need for timely diagnosis and ideal anatomical reposition, correct step-by-step management of the patient.
Prevention
For the purpose of prevention, it is necessary to avoid injuries, follow the safety rules when playing sports. It is recommended to use orthopedic shoes or shoes that have a shock-absorbing sole that can protect the foot when jumping.
If you need to land on your feet from a great height, it is recommended to group, make your legs elastic. If the first symptoms of a fracture appear, you should immediately contact the clinic.
Finally…
Today, the treatment of calcaneal fractures is a difficult task that requires an ideal anatomical comparison of the bones, as well as their retention until complete fusion. Often, damage leads to the development of contractures of the joints of the foot and lower leg, vascular disorders, osteoporosis, and so on. An improperly fused fracture often provokes the development of flat feet and arthrosis, which can cause a person's disability.
In medicine today, methods for the effective treatment of calcaneus fractures are not sufficiently developed, so doctors often make mistakes both in making a diagnosis and during the treatment of pathology. As a result, many people become disabled and their quality of life deteriorates significantly. Therefore, it is recommended to avoid traumatic situations, follow safety rules.
