Question
I am currently recovering from bilateral calcaneal fractures. I was admitted to hospital and had an open reduction and internal fixation of left calcaneal fracture and evaluation of the right under live fluoroscopy. I was actually fortunate to have had this accident while on holidays and in a large center and received excellent care.
The left heel was much worse than the right. The surgeons had quite a time trying to put it back together - they had tried a few ways and finally "We therefore placed several K-wires for temporary fixation, brought in a plate, secured the plate in position and obtained reduction. This brought the tongue piece back into better overall alignment, recreating height. With the titanium plate secured laterally, lateral wall replaced, and small cancellous bone graft placed in the large hole created by disimpaction of the 2 fragments. We were satisfied with the overall alignment and stance of the calcaneus. Multiple screws have been placed lateral to medial." (operative report). ..."We then examined the right claneus under fluoroscopy, applied a medial and lateral direct pressure to narrow down the fragments to keep them as thin as possible for impingment. Satisfied with the overall alignment, we resplinted the calcaneus with similar posterior splint bubbled around the calcaneus." They went on to indicate that a subtalar fusion months down the road might be needed.

I am caucasian, 57 year old female with absolutely no health concerns. I have been active in athletics all my life, love hiking in the mountains etc. My concern now is rehabilitation. I live in another country from where I injured myself and in a smaller center. I have an orthopedic physcian following my case but I have concerns over rehab. protocol. It has been almost 3 months non weight bearing - x-rays indicate my right heel is doing well and it is feeling very well. I can bear slight weight on my toes - I have not had any weight on either leg yet but do put my toes on the floor to test them out. My left foot has most of the feeling back in it now but my right foot feels very much "asleep" - numbness and tingling especially on the bottom. Although I am not troubled with heel pain per se now, I have shooting nerve pain intermittedly. My doctor indicated that I should start weight bearing on both feet now - his comment was , "We can't keep you non weight bearing forever." I am anxious to regain the use of my feet but would feel better if I had an idea of what is common protocol in this field. Could you comment on this for me?

thanks so much -

Answer
Hi Susan

Non-displaced calcaneal fractures require a period of rest and partial to complete immobilization. Treatment options include hard casts or removable cam walkers. The duration of symptoms and time necessary for adequate healing varies with the age, nature of the fracture and general health status of the fracture. It is not unusual to find calcaneal fractures that are symptomatic up to 4-6 months post injury. So the three months you have been non weight bearing is well within the time period mentioned.

The calcaneal fracture is best followed by bone scans, so if you have not a bone scan yet, that might be an option to ask your orthopedist about having you look at to see how the progress of healing is going.  Another option would be to ask your doctor about going partial weight bearing rather than full weight bearing.  My thinking is that if you go to full weight bearing all at once, it might be painful for you and you may not walk correctly which might cause problems down the road.  So ask your orthopedist about physical therapy to ensure that you go from non weight bearing to weight bearing at the correct pace for your body.

As far as nerve damage goes, when your body has the amount of surgery that you have had, there is always a chance that you may have nerve damage.  I had some nerve damage in the knee from hip surgery.  My doctor told me that the rule of thumb would be nerves take about 18 months to heal.  If you have not seen any improvement in 18 months, chances are that you will have damage to the nerves in the area.  After two years of healing I have nerve damage, but it's not terrible and I can live with it.  

It might be a good idea to see if you can get a referral to a neurologist to check out the nerves in the area.

Please be aware that my area of expertise is in hip surgery from a patient point of view so whatever advice I have given you, please double check it with your doctor.  In general, if you are not happy with a surgeon, please seek a second opinion.

Sharon Davis