Calcaneal fracture fixation is an operation to reconstruct a broken heel bone (calcaneus). These fractures often involve the subtalar joint surface and require surgery to restore foot shape and function.
An incision is made on the outer side of the heel. The fracture fragments are carefully elevated and realigned, restoring the joint surface and the height and width of the heel bone. The repair is held with a plate and screws. In some cases, bone graft is used. The operation takes one and a half to three hours.
Surgery is recommended for displaced calcaneal fractures involving the subtalar joint surface. Without surgery, the heel may heal flattened and widened, causing chronic pain, difficulty with footwear, and early arthritis.
Non-operative management with elevation, ice, and early range-of-motion exercises. This may be appropriate for undisplaced fractures, fractures in patients with poor blood supply (such as heavy smokers or diabetics), or in patients who are not fit for surgery. Results are less predictable than surgical treatment for displaced fractures.
Surgery is typically delayed for one to two weeks to allow swelling to settle. The 'wrinkle test' is used — surgery proceeds when skin wrinkles return, indicating reduced swelling. CT scanning is essential for planning. Smoking cessation is critical.
The aim is to restore the shape of the heel, the subtalar joint surface, and foot function. Most patients can return to walking in shoes, though the heel may remain somewhat wider than before. Some patients require subtalar fusion later if arthritis develops.
The most significant risk. The lateral heel skin is vulnerable. Wound complications occur in 10–25% of patients.
Loss of side-to-side foot movement is expected.
Heel and foot swelling persists for many months.
Superficial or deep infection. May require further surgery. Risk is higher in smokers and diabetics.
Numbness on the outer side of the foot. Common minor complication.
May develop despite good surgical reconstruction and may require fusion.
Tendons running behind the outer ankle may be irritated.
Rare but requires urgent treatment.
General or spinal anaesthesia with a nerve block for post-operative pain relief. The patient is positioned on their side.
Non-weight-bearing for six to twelve weeks. Elevation is critical in the first two weeks to protect the wound. Gentle ankle and subtalar exercises begin once the wound is healed. Gradual return to weight-bearing in a supportive boot. Full recovery takes six to twelve months or longer. A wider heel may require modified footwear.
Wound check at two weeks (critical). X-rays at six weeks and three months. Physiotherapy for ankle and foot rehabilitation.
Operating through very swollen tissue dramatically increases the risk of wound problems. Waiting for swelling to settle is essential for a safe outcome.
Most patients return to walking comfortably, though side-to-side foot movement is usually reduced. Some adaptation to uneven ground is needed.
Smoking severely impairs wound healing and bone healing. The lateral heel skin has a tenuous blood supply, and smoking increases wound complication rates significantly.