The calcaneus fracture: cause, treatment, and rehabilitation after injury
How to avoid serious consequences if the fracture of the calcaneus: treatment and rehabilitation
Humans evolved to bipedal, thereby transferring all the load to main supporting element of your body stops. With our feet we take off the spine and joints a significant load, but what load they have to withstand.
Calcaneus – the largest in the human foot and is able to withstand heavy loads. But, while our skeleton is covered with adamantium, all parts of our body can fail as a consequence of injuries. And even those hardy heel bone is no exception.
The calcaneus fracture – bone damage due to trauma. As a rule such injuries cause considerable damage to its owner and can cause a variety of complications. In the fall on the heels of the Mas, the whole body is transmitted to the talus, which cuts into the calcaneus and thereby divides it into parts.
The cause of trauma
The most common causes of damage to the heel bone can be called a fall or jump to his feet from a height. Not last place is occupied in the statistics of road accidents and simply injury.
We should not forget about the possible fatigue fracture of the bones that occur due to constant overload of the bone, in which there are any anatomical defects. This injury is not rare in the army recruits, athletes and people who ignore the measures of protection.
Classification of fractures
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Fractures of the calcaneus into several main groups.
That, in turn, are:
- fracture of the lateral process located on Bagratuni bone;
- fracture similar to the «duck beak»;
- fracture of the medial process, located on the hill bone;
- broken hill in the place where the tendon attaches.
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Which, like intra-articular fractures of the heel are divided are:
- without displacement;
- with displacement.
It is also common multisplintered fractures.
The symptoms of fracture of the calcaneus is easily recognizable:
- palpation inherent in heel pain;
- bleeding from the foot and the heel;
- increase the size of the heel;
- a sharp pain and the inability to stepping on the injured leg;
- movement of the ankle joint is limited.
It is essential that the victim told the doctor exactly how the fracture happened. Also a person must report if he had any other injuries or illnesses, such as diabetes. Also inform your doctor about taking any medications.
Fracture of the calcaneus often pales against the background of a more «bright» injuries such as an ankle fracture or spine. So to all the people, injured in a fall from a height must see on the subject of heel fractures.
To determine the type of fracture, its length and other information examine both feet in the lateral and axial projections. When viewing radiographs pay attention to the angle of Böhler that the majority of trauma considers the starting point of the follow-up assessment of treatment outcomes.
The angle formed by the intersection of the two lines. With normal rates, this angle is 20-40°. Depending on the degree of fracture of the angle of Böhler can be reduced, and in some cases may have even negative values.
Treatment for trauma
The patient should limit food and give to eat and drink only if you know that in the next day to the fracture clinic you not get.
Excluded applying tight bandages. A tourniquet is applied only if a strong bleeding. A tourniquet should not be kept more than 2 hours.
Under the foot should be put a soft cushion, it can be folded improvised so that the foot was above the torso. The injured foot to wrap something soft and not very noticeable. Not be amiss to ice and not to delay the delivery of the victim to the hospital.
No later than three weeks after fracture of the calcaneus is required to hold conservative or operative treatment. This problem is highly relevant for the breaking of the calcaneus is not always effective treatment. Injuries of the calcaneus diverse, so the views of doctors regarding the classification of fractures and their treatment differ to this day.
At fracture of the calcaneus and the presence of offsets in the mandatory local anesthesia. As soon as the limb is numb, the doctor by a method of manual reposition places the bone fragments that were deformed to their original place.
If on the break with just a plaster and does not reposition, then there is a high risk of development of atrophy of leg muscles, this will be greatly restricted movement, particularly in the ankle.
At fracture of the calcaneus without displacement the limb is fixed with the application of the plaster bandage, which comes to the knee. The foot should be in the position of small inflections. This will prevent the possible re-displacement of any bone fragments. If the fracture is unstable without displacement, should conduct an internal splinting of the bone. Using this method, continue moving the joints of the foot, and the rehabilitation done after removed the device.
When correcting intra-articular fractures with displacement, also use a method of splinting.
The most severe considered multisplintered and fragmented fractures. Trauma of the limb on the heel and on the foot are installed with special fasteners that connect the systems on the hinges with the presence of a support fixed to the bones of the lower leg.
Perhaps one of the most popular methods of treatment for people who have fractures of the heel bone and talus bone healed incorrectly, believe that arthrodesis of the subtalar joint. Surgery Introduzione joint due to the deformation will eliminate the pain.
The nature of injuries and treatment are directly dependent on the list of factors in each individual case. Everything counts: the location of the foot during the fall, at the time of impact, direction of force, the weight of a person.
Depending on the injury mechanism chosen method of treatment. The majority of trauma converge in the idea that at the moment the best treatment is the Ilizarov apparatus.
Provided good treatment results with a significant decrease in the number of complications. Unfortunately, today a lot of people who are in rehabilitation after a fracture of the calcaneus treated lightly, do not pay enough attention to long-term recovery process.
As a result of this attitude is the development of posttraumatic flat feet, in some cases, the subtalar joint can be affected by the deforming arthrosis.
Doctors disagree on the timing of immobilization. Some believe that after fixation, external immobilization is not required and permit the load leg for 2 months after surgery.
Others believe that load is permissible only after six months. The patient is prohibited to go within the first 3-4 weeks. After getting rid of plaster require different physical therapy procedures: physical therapy with fracture of the calcaneus and massage.
This is very important because a person needs to develop the leg immobilized for a long period of time. Recovery after calcaneus fracture is to perform special exercises, the purpose of which is the speedy recovery of the patient.
The first stage — training on the exercise bike, with greater reliance on a sock, and later with full pushes on the heel. This load is good for the development of the foot and helps to restore the mobility of the legs. Then you gradually become on the foot, gradually shifting the weight on the toe, on the foot. Walking is encouraged within reasonable limits.
More detailed instructions will appoint a specialist based on the characteristics of the fracture.
It should be remembered that the heel fracture rehabilitation must move forward one step, because failure to comply with reasonable physical activity may be one of the reasons for re-displacement of the heel bone, and it is fraught with consequences.
Depending on the type of bone fracture rehabilitation may continue for a couple of months and couple of years. Typically, the first traffic stop is permissible when they do not cause severe pain. Usually in a closed fracture without displacement or uncomplicated fracture of the absolute recovery comes in 3-4 mesyatsev, then the patient can live their daily lives.
Complications that can cause injury
The outcome of the calcaneus fracture is not easy to predict. Therefore, even compliance with all recommendations of the doctor makes no warranty that it will be possible to avoid complications.
The most common complications are:
- irritation of the tendons of the fastening straps;
- irritation the field of stitches or an open wound;
- chronic pain;
- the collapse of the bone;
- pathological changes of the joints;
- a complication of infection;
Injury to the calcaneus is not so much a threat the fact of its appearance, how many the possible complications that may result. To avoid this injury.
If this was not possible, should immediately contact the doctor, strictly following not only treatment but advice on rehabilitation.