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Abstract: Heel fracture is a common injury of the foot, most often injured in young adults. When a heel fracture occurs, most patients are concerned about the residual disability, but in fact, a good prognosis can be obtained if medical treatment is timely and the fracture is mild. In this case, the patient developed a heel fracture after a fall from a height. After admission to the hospital, he actively cooperated with the doctor to take conservative treatment and eventually achieved ideal heel function with a good prognosis.
[Basic information] Male, 38 years old
Disease Type】Heel fracture
Hospital】Harbin First Hospital
Date of Consultation】May 2022
Treatment plan】Manipulation + external fixation in plaster
Treatment Period】7 days in hospital
Effectiveness】Fracture repositioning and fixation, pain relief
I. Initial consultation
The patient came to our hospital because she had pain in her heel after a fall from a height and was worried about a fracture. After clarifying the circumstances of the fall, we initially suspected that the patient had a heel fracture. This type of fracture is an extra-articular type of fracture, which usually does not require surgical treatment if the subtalar articular surface is not involved and has a better prognosis compared to the intra-articular type of fracture. After radiographs, the patient was confirmed to have a displaced heel fracture, but fortunately the displacement was not significant and there was only a mild widening of the heel body and a reduction in heel height. In order to restore the stability of the fracture end of the heel body and to promote healing of the heel fracture, manipulative repositioning and external fixation in plaster were considered. After full communication with the patient, he was informed of the treatment method and the fracture recovery process, the patient accepted the treatment plan and would actively cooperate with the treatment, so he was admitted to the hospital.
Treatment process
After admission, the patient underwent a 3D CT examination and, on the basis of the findings, underwent traction therapy to promote heel fracture repositioning through continuous heel traction. Subsequently, the X-ray was reviewed to confirm that the repositioning was satisfactory, and the heel fracture was fixed with a cast. After the fixation was completed, it was confirmed that there were no abnormal changes in peripheral blood circulation and toe movement and sensation, and the affected limb was elevated continuously to accelerate venous return and lymphatic fluid return to eliminate swelling at the heel fracture site as soon as possible and avoid affecting the blood supply to the limb. Since the patient’s pain was not severe and did not require continuous use of pain medication, the patient was given oral ibuprofen extended-release capsules and discontinued after 3 days. During the treatment period, the patient was encouraged to insist on toe flexion and extension activities every day to accelerate the swelling and promote the recovery of blood supply to the fracture end.
(After repositioning)
III. Treatment effect
The patient’s fractured end of the heel bone was repositioned after the treatment of manual repositioning and external fixation in plaster. Although the complete anatomical repositioning was not achieved, the functional repositioning criteria could be met, and after the fracture was completely healed, it would not cause significant impact on the weight-bearing function of the heel bone. After 7 days of hospitalization, the patient’s pain symptoms gradually disappeared after the heel fracture was repositioned, and he could walk on one foot with double crutches and gradually resume daily life. At this time, the toes could move freely without restriction, and the toe activity did not induce the reappearance of painful symptoms at the heel fracture site, so the discharge criteria were met and the patient was discharged from the hospital for recuperation, and was instructed to review regularly.
IV. Notes
We are glad that after a series of treatments, the patient’s fracture pain disappeared and he recovered well, and was discharged from the hospital successfully. However, since the heel bone is more important for walking and weight-bearing, the patient still needs to pay attention to the following conditions after discharge.
1. Attention should be paid to avoid using the heel part for weight-bearing in daily life before the fracture heals, otherwise it will not only affect the smooth healing of the fracture, but also cause the arch to collapse and increase the load on the plantar fascia and muscles of the foot, causing persistent plantar pain symptoms and, in serious cases, affecting normal weight-bearing walking and sports in the future.
2, during the external fixation of the heel fracture with a cast, it is necessary to closely observe the blood supply, sensation and movement of the toe, if there is numbness or bruising of the toe, it is necessary to promptly go to the hospital for outpatient follow-up to confirm whether the cast is fixed too tightly to prevent serious consequences such as ischemic necrosis of the toe.
3. If the cast is loose, it should be replaced by a new one in time to make sure that the fracture is fixed firmly.
V. Personal insight
The heel fracture is a kind of extra-articular fracture, and in most cases, the injury is not serious, and the fracture can be fully healed after manual repositioning + external fixation of the cast, and the prognosis is relatively good to meet the needs of daily life movement. If a serious intra-articular fracture of the heel bone occurs, it may induce traumatic arthritis, which may seriously interfere with future life, work and sports, and often requires consideration of surgical internal fixation treatment. The patient in this case had a relatively mild heel fracture and was actively cooperative and compliant during treatment, thus achieving a more satisfactory prognosis. Therefore, after the occurrence of a heel fracture, patients should not be overly alarmed and need to undergo timely imaging to confirm the severity of the fracture so that the next step of treatment can be carried out in a timely manner to restore health as early as possible.