What is a calcaneal fracture?
A calcaneal fracture is a break in the calcaneus, or heel bone — the large bone that forms the rear foundation of the foot. The calcaneus connects with the talus and cuboid bones, and the joint formed between the talus and calcaneus, called the subtalar joint, is essential for normal foot function and the way your ankle rolls side to side.
The heel bone has been compared to a hard-boiled egg: a thin, hard outer shell surrounding softer, spongy bone inside. When the outer shell breaks under significant force, the bone tends to collapse and fragment rather than break cleanly, which is part of why these injuries can be so severe. When the fracture involves the subtalar joint, it can lead to long-term arthritis and chronic pain if not managed carefully. If your injury involves the ankle joint itself rather than the heel bone, our ankle fractures page may be more relevant.
What are the symptoms of a calcaneal fracture?
Symptoms differ somewhat depending on whether the fracture results from a sudden traumatic injury or develops gradually as a stress fracture.
Traumatic fractures typically cause:
- Sudden, significant heel pain and an inability to bear weight
- Swelling in and around the heel
- Bruising of the heel and ankle
Stress fractures tend to cause:
- Gradual, generalized heel pain that develops over days to weeks
- Swelling in the heel without a specific injury event
What causes calcaneal fractures, and who is at risk?
Most calcaneal fractures result from a traumatic, high-force event rather than gradual wear. Common causes include:
- Falling from a height, such as off a ladder
- Automobile accidents involving a crush injury to the heel
- A severe ankle sprain that also involves the heel bone
- Repetitive stress or overuse, which can lead to a stress fracture over time rather than a single traumatic break
Fracture patterns are generally grouped into two categories. Intra-articular fractures are the most severe, involving the subtalar and surrounding joints along with cartilage damage. Extra-articular fractures do not involve the joint and include avulsion fractures, where a fragment of bone is pulled away by the Achilles tendon or a ligament, crush injuries with multiple bone fragments, and stress fractures from overuse.
How do we diagnose a calcaneal fracture?
We diagnose a calcaneal fracture by reviewing how the injury happened, performing a hands-on examination of the foot and ankle, and obtaining x-rays. Advanced imaging, such as a CT scan, is commonly required to fully map out the fracture pattern, especially for injuries involving the subtalar joint, since these details significantly affect treatment planning.
How is a calcaneal fracture treated?
Treatment depends on the type of fracture, whether the joint is involved, and how displaced the bone fragments are. Because the heel bone tends to collapse and fragment, treatment decisions for calcaneal fractures require careful evaluation.
Nonsurgical treatment
- R.I.C.E. protocol — rest, ice, compression, and elevation to manage initial swelling
- Immobilization in a cast or boot to protect the bone during healing
- Crutches to keep weight off the injured foot while it heals
Surgical treatment
More severe or joint-involving fractures often require surgery to reconstruct the joint surface or, in some cases, fuse the joint. Our physicians will review your specific fracture pattern on imaging and discuss whether surgical or nonsurgical treatment offers the best path to recovery.
What does rehabilitation and recovery involve?
Physical therapy often plays a key role in regaining strength and restoring function after a calcaneal fracture, regardless of whether treatment was surgical or nonsurgical. Recovery from these injuries tends to be longer and more involved than many other foot and ankle fractures, given the complexity of the bone and its role in the subtalar joint.
Because calcaneal fractures carry a meaningful risk of long-term complications, including arthritis, stiffness, and chronic pain, improper bone healing, decreased ankle motion, a limp from heel collapse, or the eventual need for additional surgery, close follow-up throughout recovery is especially important. Some patients require long-term bracing or an orthotic device to manage ongoing symptoms.
When should you see a podiatrist for a heel injury?
Seek prompt evaluation for any heel injury involving a fall from height, a car accident, or a crush injury, even if you are able to bear some weight. Sudden, significant heel pain with swelling and bruising after an injury should not be assumed to be a simple bruise.
If you have gradual, unexplained heel pain that builds over days to weeks, especially with a recent increase in activity, this can be a sign of a stress fracture that also needs evaluation. When you are ready, you can request an appointment at either of our Northern Utah offices.
Why choose Wasatch Foot & Ankle Institute?
Wasatch Foot & Ankle Institute is a locally rooted podiatry practice serving Farmington, South Ogden, and the surrounding Davis and Weber County communities. Our board-certified, fellowship-trained physicians focus exclusively on the foot and ankle, including complex fractures of the heel bone and subtalar joint.
That focus lets us offer complete calcaneal fracture care under one roof — from precise diagnostic imaging to casting, bracing, and surgical reconstruction when it is needed, followed by guided rehabilitation — so your care can advance without a referral elsewhere. We treat patients from both of our clinics; learn more about our Farmington and South Ogden locations or call the office nearest you.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This page is for general education and is not a substitute for an in-person evaluation.