Treatment options for heel fractures will depend on the severity of the injury and the extent of soft tissue damage, among other factors. In general, the goal of treatment is to restore the heel’s natural anatomy, which often involves surgery. However, if the pieces of broken bone have not been displaced by the injury, a cast or other immobilizing device may work instead of surgery. In this case the patient will not be able to put weight on the heel until the bone completely heals, which may take six to eight weeks.
Surgery is used to treat displaced bones. Open fractures—where the bone has broken through the skin—require immediate surgery, as the bones are exposed to the elements, while surgery for a closed fracture may take place after the initial swelling has gone down. Two types are surgery are commonly used for calcaneus fractures: open reduction and internal fixation (ORIF), and percutaneous screw fixation. In the former, bone fragments are first repositioned into their normal alignment, and then are held together with screws and/or metal plates. In the latter, when the bone pieces are large, they are moved back into place without the surgeon making a large incision either by pushing or pulling them. Screws are then inserted through small incisions to hold the pieces together.
With or without surgery, rehabilitation is usually required.