From the Guidelines
Surgery is the usual treatment for heel fractures, with simple immobilization being appropriate for small, nonarticular, or minimally displaced fractures. The treatment approach for a heel fracture depends on the severity and displacement of the fracture, as well as the presence of any articular involvement 1. For non-displaced or minimally displaced fractures, non-surgical management may be considered, including rest, ice, compression, and elevation (RICE protocol), along with non-weight bearing on the affected foot for a period of time. However, for more complex fractures, especially those involving the joint surface or significantly displaced, surgical intervention is often necessary to ensure proper alignment and healing of the bone fragments.
Key considerations in the treatment of heel fractures include:
- The severity of the fracture and the degree of displacement
- The presence of any articular involvement
- The overall health and activity level of the patient
- The potential for long-term complications such as arthritis, chronic pain, and altered gait
In terms of specific treatment protocols, the use of NSAIDs like ibuprofen or naproxen for pain management is common, along with the potential use of prescription pain medications for severe pain 1. The recovery period can vary significantly depending on the treatment approach, with non-surgical management typically requiring several weeks of non-weight bearing, followed by gradual return to activities, and surgical intervention requiring a longer recovery period of several months.
The goal of treatment is to achieve optimal outcomes in terms of morbidity, mortality, and quality of life, and to minimize the risk of long-term complications 1. As such, the treatment approach should be individualized to the specific needs and circumstances of each patient, taking into account the latest evidence and guidelines 1.
From the Research
Treatment for Heel Fracture
The treatment for a heel fracture can vary depending on the severity and type of fracture.
- Immobilization is a critical part of treatment for ankle fractures, which can include the use of plaster casts or short-leg walking boots (WBs) 2.
- The use of WBs has been shown to result in faster functional recovery and allow patients to return to normal activity at a faster rate compared to plaster casts 2.
- However, immobilization may produce ankle contracture (loss of flexibility), and recovery of normal ankle dorsiflexion flexibility typically takes longer than the initial period of immobilization 3.
- Surgical fixation may be necessary in some cases, and the use of plates and screws can be effective in stabilizing the fracture, but complications can occur if the implant is not properly selected or applied 4.
- Immediate or delayed operative treatment of fractures of the ankle can produce similar functional results, but delayed operation may result in longer postoperative immobilization and hospital stay 5.
- Manual physical therapy following immobilization for stable ankle fracture can result in significant improvements in self-reported function and ankle range of motion 6.
Treatment Options
- Immobilization using plaster casts or short-leg walking boots (WBs)
- Surgical fixation using plates and screws
- Manual physical therapy following immobilization
- Immediate or delayed operative treatment
Considerations
- The choice of treatment depends on the severity and type of fracture
- Immobilization can produce ankle contracture (loss of flexibility)
- Surgical fixation requires proper selection and application of implants to avoid complications
- Manual physical therapy can result in significant improvements in self-reported function and ankle range of motion