Calcaneal fractures

Complications

Early

• Massive tissue swelling and skin problems, requiring prolonged elevation, ice and Flotron therapy
• Compartment syndrome May occur in up to 10% of patients. Myerson (1991) has described the technique of decompression.
• Complications of surgery, particularly wound failure and deep infection. Major flap failure in the extended lateral approach often needs plastic surgical involvement to obtain healing. The best management is prevention by good patient selection.

Late

• Malunion leading to:
• Loss of heel height and increased heel width – can usually be accommodated in a shoe
• Malleolar impingement
• Peroneal tendon entrapment – may require a decompression or calcaneal osteotomy. Romash (1993) described a reconstructive osteotomy with bone grafting in seven patients. All were relieved of lateral impingement, six were pain-free and four had returned to work.
• Entrapment neuropathies – usually medial calcaneal nerves or the nerve to quadratus plantae. May settle with local treatment or injections but occasionally require open neurolysis
• Degenerative arthritis of subtalar or calcaneocuboid joint - subtalar pain with mild degenerative changes may respond to arthroscopic debridement (Elgafy and Ebraheim 1999). For patients with degenerative arthritis in the subtalar or calcaneocuboid joint, the best option is an arthrodesis. This may be carried out in situ or a tricortical bone block may be used to restore calcaneal height and treat secondary ankle impingment (Carr et al 1988, Trnka et al 2001, Rammelt et al 2004) . No randomised prospective studies have been done to compare these two techniques.
• Heel pain – soft heel pads in the shoe may help and nerve injury or entrapment should be considered, but often soft tissue damage to the heel pad is difficult to treat and may be the main long-term disabling symptom
• Gait abnormalitiy due to stiff subtalar joint
• Deep infection may require further debridement and possible plastic involvement to obtain closure
• Toe clawing due to unrecognised compartment syndrome
• Complications of surgery, especially infection, nerve injury and soft tissue instability