The Lover's Fracture

The calcaneus bone, or heel bone, is among the most commonly fractured tarsal bone in the foot.  Calcaneus fractures account for 1-2% of fractures in the body.  

Calcaneus fractures are also known as the Lover’s fracture.  

Calcaneal fractures often occur due to a jump from a height, which is how the term “Lover’s fracture” was coined because a lover may jump from great heights to escape from a lover’s spouse or boyfriend.

Calcaneal fractures are generally traumatic fractures occurring from motor vehicle accidents, muscular stress, or falls from a height.  We usually see these injuries in worker's injury claim cases, whereby someone has fallen off of a ladder or rooftop. 

Calcaneal fractures are categorized based on whether the fracture is displaced (greater than 2mm displacement), open (with soft tissue or bony structure exposed), closed (with skin and soft tissue intact), or comminuted (3 or more pieces).  Treatment for calcaneal fractures varies based on the type of fracture.  Standard radiographs and CT scan are used to diagnose calcaneal fractures, and determine the severity of the injury.  Pain over the heel, inability to walk, or a hematoma that extends to the sole of the foot are all signs of a calcaneal fracture.  

Presence of a hematoma on the sole is known as the “Mondor Sign”.  In a non-displaced fracture nonsurgical treatment may be sufficient.  Displaced or comminuted fractures typically require surgical treatment consisting of some type of fixation with metal plates or screws or more recently we have used multiplanar external fixation for restoration of height, the angle, and joint space of the posterior facet in the subtalar joint. 

In closed fractures surgical treatment is often postponed until swelling has subsided.  In open (exposed soft tissue or bone) or avulsion fractures (when a tendon pulls off a piece of bone), more urgent treatment is required.  Open fractures are exposed to the environment and need to be cleaned and then surgically corrected within a short time period to prevent infection which is another advantage of external fixation. 

 

Minor calcaneal fractures usually heal within a few months, and cause minimal long-term limitations.  More severe fractures may take years to heal, and never return to the previous condition.  

Long-term complications may include pain, limb length discrepancies, and changes in gait with chronic swelling, and reduced endurance and strength.  

Early treatment by the foot and ankle surgeon (ie Family Foot and Leg Center)  is the key to minimizing long-term complications. 

-Dr Timm

Rollerblading and your ankle health.

Although rollerblading is a low-impact sport, The Consumer Product Safety Commission reported an average of over 32,000 inline skating injuries every year from 2003 to 2007, according to the National Safety Council. Most injuries affect the upper body, but ankle injuries are one of the most common injuries to the lower extremities.The firm boot of an inline skate provides good ankle support when the skate fits properly, but fit is key. Protecting your ankles means not just following proper skating technique but also shopping smartly for your inline skates.

Often times the ankle will be supported well within the confines of the device. However knee sprains and syndesmotic injury can occur (high ankle sprain) in the right setting while rollerblading. More often foot injury is likely, with blisters, metatarsalgia, and even mild neuropraxia in the wrong rollerblade configuration. This is a general guide to choose the right blades for your feet.

Dr Timm

Diplomate American Board of Podiatric Surgery

Selecting Skates

Step 1

Shop for skates after a day of activity to compensate for any swelling of the feet that occur while rollerblading.

Step 2

Pick skates for your gender, especially if you are a woman. While women can wear unisex skates, those designed especially for a woman better fit a woman’s narrower Achilles tendon and lower position of the calf muscle, notes Liz Miller, author of “Beginner's Guide to Inline Skating.”

Step 3

Look for skates that lace up and buckle at the top. The combination provides a more secure fit for ankle support.

Step 4

Squeeze the plastic support in the boot. It should be firm and unmovable.

Step 5

Try on skates wearing a pair of thick, absorbent athletic socks -- the same type of socks you’ll wear when skating.

Step 6

Wear the skates for at least 15 minutes before making a purchase. When laced and buckled, the skates should feel snug, but not so tight that any part of your foot feels pressure.

Skating

Step 1

Stretch before skating. To prevent ankle injuries, focus on your feet: Flex and point your toes and rotate your ankles in circles.

Step 2

Kick your feet into the back of your rollerblades before lacing and buckling up.

Step 3

Warm up by gently skating around for five minutes.

Step 4

Match your skating location to your skating ability. If you are a new skater, begin on a large patch of level grass. Empty tennis courts and parking lots are also good places to learn.

Step 5

Bend your knees when you skate to lower your center of gravity. Skate with a wide stance if you are new to the sport. Skate with a shoulder-width stance if you are an experienced skater. A narrower stance gives you better control for tricks, but a wide stance helps beginners maintain balance.

Secrets of Chronic Achilles Pain

1) NOT all posterior heel pains are tendon problems.

We will provide a thorough examination, which includes diagnostic ultrasound, radio graphs, and clinical exam with history taking to provide the best possible outcome for your pain. There are several other structures which are present and could be treated in a different manner than any straight forward Achilles tendinitis.  Noted above, there is a bursa which is present here and can often be the root cause of pain secondary to bursitis. This is treated differently than Achilles tendinitis. This may also require MRI to determine how much of the inflammation is related to bone versus soft tissue. Additionally, and more rarely, a stress fracture can cause this pain in the calcaneus. This is not common but we check for this as well.

2) Tendon tears do NOT always require surgery.

After clinical examination and proper staging/grading of the extent of the tear, we have had success in treating Achilles partial tears and even ruptures non-surgically in select patient populations. We have a variety of techniques at our disposal in order to facilitate the healing process if surgery is not indicated. In the case of chronic tears there are several nonsurgical treatments that work, particularly PRP injections, High energy shock-wave treatments, and even physical therapy with anti inflammatory ultrasound.

3) Bone spurs are NOT always relevant. 

Often times patients will state that they "Have had a spur in the past but it went away". Usually any bone protuberance which is either palpable or visible on a plan radio-graph or MRI will NOT go away spontaneously ever and always if indicated will need resection if it is the root cause of the symptoms. In most cases the spur is not the root cause of the symptoms, and is not required to remove it, but there are far too often very large spurs which are not even symptomatic that are visible on X-ray examinations in many of our patients, therefore backing up further the concept that bone spurs are not always the real problem.

Bio-mechanically a bone spur will exist in areas of either repeated chronic trauma, or areas of chronic taut insertions. Rarely is this an isolated tumor of bone, and that being said, it is often not necessary to remove the bone spur.


Dr Timm

Board Certified by the American Board of Podiatric Surgery