Percutaneous calcaneus surgery

Fracture

What is the calcaneus?

The calcaneus (or calcaneus) is the heel bone, located in the back of the foot. It is the largest bone in the tarsus, which is the part of the foot between the midfoot and the tibia (the largest bone in the leg). It is located just below the ankle under the talus. This large spongy bone is made up of 3 parts and 6 faces. It has an elongated and flattened shape allowing the heel to be placed flat.

The calcaneus is important because it is connected to many other bones, muscles, and tendons in the foot and ankle, which work together to provide normal foot function. The Achilles tendon is implanted in the calcaneus.

The calcaneus is a sturdy structure that is designed to support the body's weight when walking and running.

Symptoms and diagnosis of calcaneus fracture

Calcaneus fractures are relatively uncommon. Calcaneus fracture occurs in the heel, specifically in the bone called the calcaneus.

Calcaneus fracture and pain may occur due to:

a direct impact on the heel
a fall from a significant height
a sports accident

When it comes to calcaneus fracture, symptoms include severe pain in the heel, swelling, bruising, and difficulty walking or bearing weight on the affected foot. In some cases, a calcaneus fracture can also cause hindfoot deformity. Unlike a typical fracture, considerable force must be applied to cause a heel fracture. This type of fracture can therefore be accompanied by other lesions such as various fractures or skin damage (wound, disrepair, separation).

Calcaneus fractures should be treated early to evaluate the fracture and see if surgery is warranted. The objective is to restore the correct anatomy, particularly in the joint areas, in order to avoid early complications and osteoarthritis (in the medium and long term). Dr. Lopez can offer you different treatments such as functional, orthopedic treatment or percutaneous surgery for foot fractures.

In order to diagnose the calcaneus fracture, Dr. Lopez first carries out a clinical examination of the foot. He will ask you about your symptoms and the type of pain you feel.

Additional examinations such as a CT scan and an x-ray are essential in order to carefully analyze the pathology.

Non-surgical treatments of the calcaneus in case of fracture

Treatment of the calcaneus in the event of a fracture depends on the severity of the fracture and can vary from simple immobilization, with a cast or walking boot, to surgery depending on the severity of the fracture and whether or not it is present, associated complications.

Conservative treatment will always be preferred when the case allows. It can be implemented in cases where the fracture does not affect the joint or in non-displaced fractures.

Several therapeutic measures can be considered:

the application of a splint or cast to immobilize the foot
not bearing weight on the foot from between 3 to 8 weeks depending on the fracture and its stability
physiotherapy sessions following removal of the cast in order to regain full mobility
custom-made foot orthotics to optimize healing

In the event that the calcaneus fracture has the following characteristics:

multiple, displaced bone fragments
joint damage
a loss of its overall shape
cortical blow
a dislocation or subluxation

After analyzing the benefit/risk balance, Dr Lopez can suggest treating the calcaneus fracture with surgical treatment. There are 2 types of surgery: open surgery (large 15cm incision) and minimally invasive and percutaneous surgery.

Percutaneous calcaneus surgery

Percutaneous calcaneus surgery is performed under general or regional anesthesia. To determine the type of anesthesia you may benefit from, a pre-anesthesia consultation must take place. During this consultation, the anesthesiologist will ask you questions about your general health and any allergies you may have.

Pain management is a key component of the care pathway. Locoregional anesthesia blocks the transmission of nerve impulses and makes the operated limb numb for a period ranging from a few tens of minutes to several hours after the operation. A painkilling treatment based on anti-inflammatories will be prescribed for the first 48 hours following the procedure as well as home infusions in most cases. It is important to follow the surgeon's recommendations in order to effectively stop the pain.

During the percutaneous surgery technique, an incision is made at the heel. The instruments are introduced through small incisions to correctly replace the bone fragments to restore bone and joint anatomy. Fixation of the fragments is ensured by the necessary equipment (heel nail, screws, pins). This technique allows access to the desired region through mini-incisions through which it is possible to insert small surgical instruments. This technique has many advantages over traditional surgery since it reduces the size of scars, limits the risk of infection, reduces pain and limits tissue damage.

When minimally invasive surgery is not possible, the fracture of the heel (or calcaneus) can be treated by an operation with the installation of plates but this requires a larger surgical approach.

Minimally invasive surgery for calcaneus fracture: recovery

In the event of a calcaneus fracture, recovery can be long.

Walking with a cane is possible 4 to 6 weeks after minimally invasive calcaneus fracture surgery. However, it is possible to place the operated foot directly on the ground but without pressing. The ankle is immobilized with a boot or cast for approximately 45 days. This deadline may vary depending on recovery. During the period of immobilization, preventive treatment against phlebitis will be administered to the patient.

It is recommended to keep the foot elevated as much as possible and apply ice to the operated foot regularly to reduce swelling and hematoma.

Depending on the case, physiotherapy sessions may be offered. Rehabilitation after calcaneus surgery includes massage, lymphatic drainage techniques, as well as active and passive mobilization of the tibia-talus joint for the first 21 days following the operation. The patient can then proceed to partial support of the foot in the swimming pool then to full support. After 2 months on average, the patient will be able to resume walking without the help of canes.

The duration of sick leave in the event of a calcaneus fracture will depend on several factors such as the professional activity and the progress of the recovery. The duration of sick leave in the event of a calcaneus fracture varies from 4 to 12 months.

The surgical equipment is removed 1 year after surgery in the presence of conflicts, discomfort or pain.

Complications of calcaneus surgery

Like any surgery, calcaneus surgery can lead to certain more or less rare complications such as:

phlebitis
joint stiffness
skin complications
the appearance of pain on the peroneal tendons
post-traumatic osteoarthritis
pseudarthrosis
the infection
algodystrophy
lack of reduction and malunion

The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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