Heel fractures are more common in clinical treatment and tend to occur in middle-aged men. Since heel fracture can severely damage the heel-spur joint, cause adhesions and stiffness, as well as spur formation and heel deformity healing, which can leave pain and motor dysfunction in the affected foot, it is important to focus on functional treatment, i.e., early movement of the affected foot and gradual weight-bearing walking, in order to achieve satisfactory functional recovery, rather than overemphasizing anatomical repositioning and strong fixation of the fracture block.
The heel bone is a cancellous bone with rich blood circulation supply, and bone discontinuity is rare. However, if the fracture line enters the articular surface or is poorly repositioned, post-traumatic arthritis and pain during weight-bearing of the heel bone are very common.
I. Pathogenesis
It is more common in adults and is often caused by a fall from a height or crush injury. It is often accompanied by vertebral fractures, pelvic fractures, head, chest and abdominal injuries, and should not be missed during the initial consultation. Achilles fracture is the most common of all tarsal fractures, accounting for about 60% of all tarsal fractures. Most of them are caused by vertical impact on the heel after falling from a high place and landing on the foot.
1. Longitudinal fractures of the heel tuberosity are mostly caused by a fall from a height, landing on the bottom of the tuberosity with the heel turned out, and shearing external force on the medial elevation of the tuberosity. It is rarely displaced and generally does not require treatment.
2, the heel nodule level (beak-shaped) fracture is a kind of Achilles tendon avulsion fracture. If the avulsion bone is small, it does not affect the function of Achilles tendon. If the fracture piece is more than 1/3 of the node, and there is rotation and serious tilt, or serious upward pull, it can be repositioned surgically and fixed with screws.
3, heel talus fracture is caused by the impact of the talus inside the talus when the foot is turned inward, which is very rare. If there is displacement, the thumb can be used to push it back to the original position and fix it with a short leg cast for 4-6 weeks.
4.Fracture of the front end of the heel is less common. The mechanism of injury is strong pronation of the forefoot plus plantarflexion. X-ray oblique films should be taken to exclude the fracture of the anterior superior heel process tear, and the short leg cast can be fixed for 4-6 weeks.
5.The fracture close to the heel talonavicular joint is a fracture of the heel body, and the mechanism of injury is also caused by a fall of the heel from a high place, or the heel is subjected to a counter-impact force from below upward. The fracture line is oblique, and on the frontal view of the X-ray, the fracture line is oblique from the inside to the outside, but not through the heel talar joint surface. In the axial view, the heel body is widened on both sides because of the osteophyte nature of the heel bone; in the lateral view, the posterior half of the heel body is displaced posteriorly along with the heel tuberosity, causing the abdomen of the heel bone to protrude into a rocking chair shape toward the center of the foot.
Second, complications
1, heel deformity or bone protrusion formation: is the most common sequelae, when the heel limiting site pressure increases, easy to form callus, pain, due to the metatarsal side of the cortex is not flat stimulate metatarsal fascia, resulting in pain due to metatarsal fasciitis.
2.traumatic arthritis of the subtalar joint
3, peroneal tendon entrapment syndrome
4, flexor claw toe deformity
5, Achilles tendon weakness
6.Posterior heel pad pain
7.Nerve impingement
8.External foot deformity
9.Infection of heel bone
C. Imaging performance
1.Fracture of the anterior process of the heel bone.
2.Vertical fracture of heel tuberosity.
3.Carrying talonavicular fracture.
4.Compression fracture of the heel bone.
5.Comminuted fracture of heel bone.
IV. Clinical manifestations
The fracture can be diagnosed based on the history of trauma, heel pain and pressure pain, wide and flat deformity of the heel bruise, outward tilting of the heel bone, and disappearance of the normal depression below the outer ankle, etc. X-ray can confirm the diagnosis, mainly by standard lateral and axial films.
V. Treatment measures
The above fracture can be rehabilitated under lumbar anesthesia by using both hands to squeeze both sides of the heel bone to correct the widening of the heel body to both sides, and at the same time, in the plantar flexion position, pulling down the heel tuberosity to restore the tuberosity joint angle. After repositioning, the calf can be fixed in a cast for 4-6 weeks.
For compression fractures of the heel that affect the subtalar joint, treatment opinions are divided and can be summarized in four ways.
1.Conservative therapy is also called sports therapy without revision. The injured foot is wrapped with an elastic bandage and the affected limb is elevated. Encourage the early start of functional movement of the affected limb and rack crutches weight-bearing. Many people believe that this method is faster than fixed therapy functional recovery, good results. Generally, patients can resume normal activities within six months, and about 3/4 of them can resume normal work. It is especially suitable for compression fractures of the heel bone that do not affect the talocrural joint.
2, bone traction treatment heel nodes under continuous traction, according to the principle of early activity treatment, can reduce the disease waste.
3.Open repositioning is suitable for young people with collapsed fractures of the lateral aspect of the talus below. The angle of the talar tuberosity and the width of the heel body can be corrected first, and then the joint surface can be surgically corrected. A lateral heel incision is made to pry up the collapsed joint surface to its normal position, and then the cavity is filled with osteophyte to maintain the reset. Postoperatively, it was fixed with a tubular cast for 8 weeks. It is believed that internal fixation at the time of surgery, without external fixation in plaster, is more satisfactory.
4, early joint fixation involves the joint of the comminuted fracture, will certainly cause irreversible damage, such as surgery within 2-3 weeks after the injury, three joints or heel and distance joint fixation, the efficacy is better than late surgery.
The above methods are general principles, but the heel fractures that affect the heel-talar joint are extremely irregular and cannot be correctly classified. The treatment is not easily uniform, the rehabilitation period is long, it is difficult to make a correct evaluation of late results, and it is impossible to identify a specific and effective treatment for each type of fracture.