The process of recovering from a fracture of the heel bone (calcaneus) due to a traumatic injury, continuous high-intensity activity, or repetitive stress is not easy and takes a lot of time. However, the chances of recovery are greater if you follow your doctor's instructions and undergo a physiotherapy program with the help of a physical therapist. If symptoms persist, such as difficulty walking or chronic pain, discuss treatment options with your doctor.
Step
Part 1 of 3: Undergoing Medical Therapy
Step 1. Consult a doctor if you experience symptoms of a heel fracture
Go to the hospital or emergency department (ER) if you suspect a heel fracture with the following symptoms:
- The heel and the surrounding area are painful, even worse when the foot is moved or stepped when you want to walk
- Bruising and swelling of the heel
- The injured leg cannot be used to walk or lean on
- If the symptoms of a heel fracture are very severe, such as deformation of the sole of the foot or an open wound on the injured foot, go to the ER immediately.
Step 2. Get tested and tested to determine how severe your heel fracture is
Appropriate therapy can be determined after the doctor has diagnosed the extent of the injury. See a doctor for a heel exam and get information about the trigger for the injury. Tell your doctor if you have any medical conditions that could affect the recovery process (such as diabetes). In addition to undergoing a physical examination, doctors usually recommend that you undergo a bone scan, for example using:
- X-ray machine to confirm the presence or absence of heel bone fracture and show the position or condition of the heel bone if a fracture occurs.
- CT scan so that your doctor can determine the type and severity of your fracture. Usually, this step is necessary if X-rays show that you have a heel fracture.
Step 3. Ask your doctor about the possibility of undergoing nonsurgical therapy
If the fracture is not too severe and there is no dislocation of the heel or sole of the foot, your doctor may ask you not to move your foot for a few weeks until it is fully healed. The doctor will place a splint, cast, or bracket on the injured leg to keep the bones from moving and prevent the injury from getting worse. Get a splint, cast, or bracket treatment and follow-up consultations as directed by your doctor for a speedy heel recovery.
- Usually, doctors also recommend that you do RICE therapy, which stands for rest, ice, compression, elevation so that your feet recover faster and reduce inflammation. This therapy is done by resting the foot, compressing the heel with a cold object, and splinting the injured leg. In addition, you need to raise the injured leg as often as possible.
- Usually, you will need to use a splint or cast for 6-8 weeks. Do not rest on the injured leg until approved by a doctor.
- The doctor will explain how to do home therapy, such as raising the foot higher than the heart and applying cold compresses to the injured heel to reduce swelling.
- Under certain conditions, heel fractures need to be treated by closed reduction methods. During therapy, the doctor will manipulate the injured foot by placing the heel bone fragment in its proper position. You will be given anesthesia while undergoing this therapy.
Step 4. Discuss the possibility of undergoing surgery for severe bone fractures
Sometimes, surgery is the best solution if the heel is fractured in several places, the bone fragments are displaced, or there is an injury to the muscles and connective tissue in the heel area. If you are advised to have surgery, ask your doctor about the risks and benefits. Also, ask for information about the postoperative recovery process.
- If the muscle or joint connective tissue is injured or inflamed, the doctor will delay surgery for a few days until the swelling goes away, but in certain cases, such as an open wound in a broken bone, surgery should be performed as soon as possible.
- If needed, the doctor will perform surgery to place screws or metal plates on the heel to prevent the bone fragments from shifting.
- After the surgery, the injured heel is wrapped in a cast for several weeks. After the cast is removed, you will need to wear special boots for a while.
Step 5. Perform home care as best as possible according to the doctor's instructions
Whatever therapy you and your doctor decide on, make sure you continue your postoperative care as directed by your doctor so that the recovery process goes well. Make an appointment with your doctor for outpatient treatment. Call your doctor immediately if you have any complaints or questions. In the meantime, you will need:
- Use crutches, a walker, or other device to keep yourself from resting on your newly operated leg.
- Take over-the-counter or over-the-counter medications to treat pain and inflammation, especially after surgery. Make sure you take your medication as directed by your doctor.
- Take antibiotics to prevent or treat infections as prescribed by your doctor.
Part 2 of 3: Undergoing Rehabilitation After Therapy
Step 1. Ask the doctor for things related to the recovery period
Healing fractures of the heel bone takes a lot of time. Its duration is determined by various factors, such as physical health, the severity of the fracture, and the therapy being undertaken. See your doctor to find out when you need to go to rehab and ask how long it will take until you can get back to your normal activities.
- Depending on the patient's physical condition, physiotherapy and rehabilitation programs may be started within the first week after therapy.
- If the fracture is relatively mild, you will need to go through a recovery period of 3-4 months before returning to your daily routine, but up to 2 years if the fracture is severe or complications occur.
- Unfortunately, fractures of the heel bone can not recover 100% so that the function of the foot and ankle is impaired or permanently reduced. Ask your doctor or physical therapist for information on how to anticipate this.
Step 2. Begin moving your feet and ankles as soon as your doctor allows you to do so
If done early in the recovery period, this step can speed up the recovery of the heel and prevent difficulty moving. Ask your doctor when you should start practicing moving your feet and ankles and how often you should do them. Usually, you have to wait until the movement is painless or the surgical wound has healed. Start practicing by doing the following movements.
- Extension and flexion of the ankle while sitting or lying down. Straighten your legs forward, point your toes forward, then bend your toes toward the back of your foot.
- Write the alphabet with the injured foot. Straighten your toes and move your feet as if you were writing the alphabet with your toes.
- Form a number 8. Straighten your toes and move your feet to form a number 8.
- Inversion and eversion. Place the sole of the injured foot evenly on the floor. Then, scroll left and right slowly. First, lift the inside of your foot off the floor and then the outside.
Step 3. Get physiotherapy to improve leg strength and widen the injured leg's range of motion
Ask your doctor to refer you to a physical therapist with experience treating leg injuries. In addition to overcoming injuries, physiotherapy is useful for maintaining long-term health of the heels and feet. This step is very effective in restoring the strength and function of the foot and ankle as an important aspect of the recovery process. When undergoing a physiotherapy program, you will need to do physical movement and be treated with other methods, for example:
- Massaging the injured body part to heal faster and prevent muscle and joint stiffness.
- Periodic evaluation to monitor foot strength and range of motion during the recovery process.
- Light impact sports with full body training (eg swimming) to maintain fitness during recovery.
- Practice walking as soon as your doctor lets you walk again.
- Learn to walk using assistive devices (eg crutches or a device to hold on to while walking) and orthotic devices (eg brackets or specially designed insoles).
Step 4. Follow the doctor's or therapist's instructions when standing or walking with the injured leg
Once you start walking again, take extra care so that the injury doesn't get worse and the implant that was placed during surgery doesn't break or shift. Check with your doctor and physical therapist regularly to find out what you can/don't do and when you can rest on the injured leg.
- Your doctor or therapist will explain how to use assistive devices, such as crutches, a walking support device, or special shoes to relieve pressure on your feet.
- Once you are ready to walk unaided, increase the pressure on the soles of your feet little by little, for example by transferring 10 kg of body weight every 2-3 days until you are able to evenly distribute the weight on both feet as usual.
Step 5. Keep your body healthy during the recovery period
The recovery process involves many aspects and progresses more quickly if you keep your body as healthy as possible. During your recovery, make sure you have a healthy diet, get a good night's sleep, and exercise as directed by your doctor and physical therapist.
- If you have a medical condition that affects your recovery, such as diabetes, tell your doctor about this so you know what to do during and after your recovery.
- Be aware that smoking can slow down the recovery process. If you smoke, ask your doctor to explain how to quit smoking.
Part 3 of 3: Preventing Chronic Symptoms
Step 1. Talk to your doctor about options for wearing an orthotic device to treat walking difficulties
Despite the best medical care and regular physiotherapy, heel fractures can sometimes cause permanent foot dysfunction, making it difficult to keep your foot on your feet, especially when walking on uneven or uphill areas. Ask your doctor or physical therapist about options for wearing an assistive device so that you can walk normally on a comfortable foot.
- In certain cases, this complaint can be overcome by modifying the shoe, for example placing heel pads, foot support, or heel wraps inside the shoe.
- Sometimes, your doctor or physical therapist may suggest that you wear special shoes designed for your foot or foot support brackets.
Step 2. Talk to your doctor to find out how to manage chronic pain
It is possible that the leg will feel pain or discomfort even though the fracture has healed. Tell your doctor if you are still experiencing pain after undergoing therapy and rehabilitation. Doctors are able to perform tests and examinations to determine the trigger for pain and explain how to treat it.
- In general, chronic pain due to heel fracture is caused by damage to the joint supporting tissue and the heel bone does not recover 100% (eg because the bone fragments are not connected properly after treatment).
- Depending on the trigger of the pain, the doctor will suggest several treatment methods, such as wearing an orthotic device (insole or foot support bracket), physiotherapy, taking medication, or surgery.
Step 3. Ask your doctor for treatment options if you experience pain after surgery
Restoration of bone fractures through surgery can cause nerve damage to the foot. If you experience nerve pain after surgery or from an injury, see your doctor to discuss treatment options. Usually, doctors use the following methods to treat nerve pain.
- Steroid injections to reduce inflammation around the nerves.
- Nerve anesthesia by injecting anesthetic into the nerves to relieve pain.
- Prescribing nerve painkillers, eg amitriptyline, gabapentin, or carbamazepine.
- Physiotherapy to speed up recovery.
Step 4. Ask your doctor if you need further surgery
Occasionally, patients require further surgery if bone recovery is not going well or complications occur, such as heel arthritis. Make sure you consult regularly with your doctor so that he can monitor the progress of your recovery and determine further therapy, such as surgery.
