Rehabilitation after Calcaneal Fractures
Fractures of the heel bone or calcaneus can be very severe injuries as the joints involved in the hind foot are very complex and very important in weight bearing and walking. Most calcaneal fractures are caused by vertical loading such as falls from a height or vehicle accidents. The fractures which result from such injuries are potentially so variable and complex that it has taken a long time to classify them and get some idea what the best treatment is for each type. When the injury occurs the patient is immediately aware of significant pain and is unable to weight bear on the foot or feet involved. Pain is often severe and unpleasant with significant swelling of the heel and ankle area of the foot.
Initial management of calcaneal fractures is rest in bed with the foot up to reduce swelling from circulatory engorgement of the limb, with physiotherapy management involving ice treatment several times per day to reduce inflammation. The physio will maintain the mobility of the other leg and unaffected joints by regular movements and muscle activity. The patient may be managed conservatively or the surgeon may decide, after CT scanning, to pursue reconstructive internal fixation with metalwork. Once the treatment has been decided and the inflammation reduced to a suitable level the physiotherapist will start to get the patient up with crutches and an assistant.
Initial mobilisation is typically non weight bearing and the physiotherapist will teach the patient to hop safely with the crutches without putting the affected foot down. Mobility exercises of the ankle and hind foot may be practised regularly to maintain and improve joint movement. Once the surgeon indicates, the physio will progress the patient steadily on to gradual weight bearing. Patients may find weight bearing very difficult and painful as the fracture may cause significant dysfunction of the joints around the fracture, particularly the subtalar joint.
Once the fracture is well united the physio will progress the treatment to weight bearing in more stressful physical situations, gait instruction and correction, balance practice on wobble boards and more advanced work if possible. Significant fractures of the calcaneum often mean that the patient cannot regain the ability they had before the injury and may always walk with a limp or with some pain. Mobilisation techniques may be performed by the physiotherapist to allow increased accessory movements of the foot joints and encouraged increased function.
Author: Jonathan Blood-Smyth