Treatment of Heel Fracture in a 3-Year-Old Child
For an acute calcaneal (heel) fracture in a 3-year-old, treatment depends on fracture severity: simple immobilization with a short leg cast or walking boot for 3-4 weeks is appropriate for small, nonarticular, or minimally displaced fractures, while displaced or intra-articular fractures involving the subtalar joint require orthopedic surgical referral. 1
Initial Assessment and Diagnosis
The diagnosis is confirmed through:
- History of trauma (typically a fall from height onto the heel) 1
- Focal pain on palpation at the fracture site 1
- Radiographic confirmation with standard views 1
For acute calcaneal fractures from falls, diffuse rearfoot pain that is poorly localized suggests intra-articular involvement of the subtalar joint, which has different treatment implications 1
Treatment Algorithm Based on Fracture Type
Non-displaced or Minimally Displaced Fractures
Immobilize with a closed split lower leg cast or controlled ankle motion (CAM) boot for 3-4 weeks 2
- A short leg back slab or CAM boot is preferred because it can be removed by the family and has fewer complications 3
- Clinical control of consolidation should occur after 3-4 weeks, at which point mobilization can begin 2
- X-ray control after 1 week is recommended to exclude secondary displacement 2
Displaced or Intra-articular Fractures
Immediate orthopedic surgical referral is required 1
- Surgery is the usual treatment for fractures with significant displacement or subtalar joint involvement 1
- These fractures require more complex management beyond simple immobilization 1
Immobilization Specifics for Young Children
For a 3-year-old specifically:
- Closed split long leg cast may be necessary if the child easily slips out of shorter casts, which is common in small children 2
- Adequate padding is essential, particularly at the heel, as skin complications occur in approximately 2% of cases 2
- Duration of immobilization is typically 3-4 weeks for stable fractures 2
Follow-up Protocol
- Week 1: X-ray to check for secondary displacement 2
- Week 3-4: Clinical assessment of consolidation and cast removal if healing is adequate 2
- Week 4: X-ray control of consolidation without cast, with further immobilization if necessary depending on extent of callus formation 2
Critical Pitfalls to Avoid
- Do not miss intra-articular involvement: Fractures involving the subtalar joint require surgical management, not just casting 1
- Prevent skin breakdown: Ensure adequate padding, especially at the heel, as this is the most common complication 2
- Do not delay orthopedic referral for displaced fractures or if there is any concern about fracture stability 1