From the Guidelines
Non-displaced calcaneus fractures should be managed conservatively with simple immobilization, as this approach is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as recommended by the American College of Foot and Ankle Surgeons 1. The goal of conservative management is to reduce pain, promote bone healing, and restore function.
- Initial treatment involves immobilization in a well-padded posterior splint or removable walking boot to protect the fracture site.
- Pain management is crucial and can be achieved with NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily, combined with acetaminophen 1000mg every 6 hours as needed.
- Elevation of the affected foot above heart level and ice application for 20 minutes every 2-3 hours during the first 48-72 hours help reduce swelling.
- As the fracture heals, partial weight-bearing can begin with crutches or a walker, gradually progressing to full weight-bearing by 6-8 weeks if radiographs show adequate healing.
- Physical therapy should start around week 4-6 to restore range of motion, strength, and proprioception, which is essential for maintaining the subtalar joint function and overall foot biomechanics. This conservative approach is effective because non-displaced fractures maintain the structural integrity of the calcaneus, allowing bone healing without surgical intervention, as supported by the American College of Foot and Ankle Surgeons' guidelines 1.
From the Research
Management of Non-Displaced Calcaneus Fracture
There is limited information available on the management of non-displaced calcaneus fractures in the provided studies. However, the following points can be considered:
- The studies primarily focus on the management of displaced intra-articular calcaneal fractures, with various surgical approaches and techniques discussed 2, 3, 4, 5.
- Non-surgical modalities, such as patient education and rehabilitation protocols, are also mentioned as important aspects of managing calcaneal fractures 6.
- The management of calcaneal fractures, including non-displaced fractures, may involve a multidisciplinary approach, with individualized care and consideration of patient comorbidities, fracture pathoanatomy, and soft tissue envelope concerns 5, 6.
Key Considerations
- The provided studies do not specifically address the management of non-displaced calcaneus fractures, but rather focus on displaced intra-articular fractures.
- Surgical approaches, such as the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach, are discussed in the context of displaced fractures 2, 3, 4, 5.
- Non-surgical interventions, including patient education and rehabilitation protocols, may play a crucial role in managing non-displaced calcaneus fractures 6.
Treatment Options
- The studies suggest that surgical intervention is generally advised for displaced intra-articular calcaneal fractures, but the management of non-displaced fractures may involve non-surgical modalities 2, 3, 4, 5.
- A comprehensive review of calcaneal fracture management highlights the importance of individualized care, multidisciplinary collaboration, and consideration of patient compliance, rehabilitation protocols, and long-term follow-up considerations 6.