/ Fractured calcaneus with no surgery help?

TomD7352 on 20 Dec 2018

Has anyone had a calcaneus fracture and not gotten surgery? Just curious they are giving me the option saying recovery is longer without surgery but the pain should be the same but in the long run it will probably cause me more pain but I know few guys that haven’t gotten the surgery and they still seem to be getting around ok which kind of makes me wonder wether or not I really need surgery or just let it heal.

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Shani - on 20 Dec 2018
In reply to TomD7352:

"calcaneus fracture" sounds like a band John Peel would recommend. 

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captain paranoia - on 20 Dec 2018
In reply to TomD7352:

Depends on the nature and severity of the fracture, surely?

I'd be asking questions about outcome, not about pain. And the nature of the surgical repair: screws, pinning, wiring, etc, and whether they would be removed, and when. Also which method is likely to give the better prognosis for arthritis.

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Dave Williams - on 20 Dec 2018
In reply to TomD7352:

When I fractured my calcanium nine years ago, I was told by the hospital pain relief team that calcanial fractures are the most painful of all due to the concentration of nerves in the heel area. So long-term pain is normal; it's just a question of how much, how long for, as well as your tolerance. I was in a huge amount of pain and was on a heady cocktail of oxycontin and oxynorm for 8 months and ended up being totally addicted to the stuff. 

If they've given you a choice between surgery or not, then I suspect that your injury isn't too severe. Lucky you in that case. I had a traumatic and severe Class V fracture and I had no choice as the only possible treatment involved surgery to reconstruct the joint (eight pins and five plates) as well as a pin (well, a pretty long screw) to fuse the sub-talar joint. Following surgery, I was on crutches for 10 months to avoid any weightbearing. 

If you opt for surgery and its associated metalwork, then if you intend to carry on climbing, the metalwork should be removed as soon as practicable. You wouldn't want to risk falling on to a heel full of metal as the resultant injury could be quite horrific. 

I was also told that recovery from a calcanial fracture may take several years. I reckon mine took in the region of 5-6 years. In that time I've had 3 operations. One to reconstruct, one to remove the metalwork 3 years later and one to clean up excess abnormal bony growth. I may yet need another as my ankle geometry is compromised (not helped by arthritis) and it is thought that this was the cause of a recent cuboid stress fracture. Every op has required a long period of re-hab and use of crutches. In addition, I have real issues with steadily increasing pain caused by the arthritis..

I can't advise you as to what to do. You know your body best and what mobility restrictions/limitations you'd be prepared to put with. However, I would caution that there may be different disadvantages with either route to recovery and you've got to really question your consultant and then go down the cost-benefit decision making route. 

Hopefully someone else on here will be able to inform you about the non-surgical route to recovery.

Good luck with whatever you decide.

Post edited at 21:33
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AdrianC - on 20 Dec 2018
In reply to TomD7352:

Hi Tom,

I broke one of mine at the end of 2014 and didn't have surgery - nor even a cast or a moon boot.  From memory it was non weight bearing for 5 or 6 weeks then I started walking on it and was running (gently!) again about  a month after that.  It's largely been pain free since then and I haven't had any annoying stuff like different-sized shoes to deal with.

But  I suspect I was quite lucky with the break as there was little or no displacement so I'm not sure how relevant that experience is.  There was quite a bit of online info and I guess there's more now so a trawl around might give you something more useful.

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Steve27 - on 20 Dec 2018
In reply to TomD7352:

Calcaneal fractures like any fracture can vary hugely in severity and recovery time.  I had an extra-articular calcaneal fracture a few years back falling off a trad route and having my gear rip.  it was put in a cast but didn't have any surgery, fortunatley it's healed 100%, I never have any problems and was back climbing 12 weeks after the injury.  

Good luck with yours, whichever route you decide to go

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stemill - on 20 Dec 2018
In reply to TomD7352:

I broke mine 8 years ago in a bouldering fall. It was an intra-articular fracture, and although i think it was fairly smashed up there was little displacement and the decision was made to go for a non-surgical option.

I didn't have a cast but was on crutches and non-weight bearing for about 8 weeks.

As soon as was back on both feet again I knew it was not quite right, my foot doesn't seem to bear weight in quite the right place with a lot of pressure over my little toe. I find it very difficult to balance on the injured foot.

This caused me quite a bit of concern to begin with but once i accepted it as the new normal it's not held me back. I've climbed harder than I did before the break and run a marathon on it so it's healed well enough.

It does cause me pain, especially after a day on the hills and I've been told it will probably become arthritic and potentially require surgery in the future but hey hopefully surgery will have moved on by then and i've got shit i want to do now!

Good luck with your recovery and try to stay positive it needn't be life changing.

Post edited at 23:55
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rachelpearce01 - on 21 Dec 2018
In reply to TomD7352:

I had a very bad calcaneous brake (the surgeon describing my heel bone as rotated 90 degrees and resembling a broken egg!). I had a really good doctor who basically gave me two options.

not having surgery - less possible complications but probably wouldn’t heal up correctly 

having surgery - more risks with infection etc . But in what he had seen in his years as a orthopaedic surgeon, he found that young people benefit from surgery and best outcomes.

so I had surgery and 2 years later I’m really happy . Climbing is no problem at all, the only niggles I get are a little bit of stiffness in the mornings or if I’ve been in a bad position for a while, and I have a bit of rubbing and a constant hard blister on the back of my heel from a pin that is sticking out slightly. But it’s not that bad and if I wanted I could get this removed quite easily. 

Hope you get some good advice and make the right decision ! I guess it depends on how bad your brake is and what sort of position it’s in to be healing back with no surgery. 

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philhilo - on 21 Dec 2018
In reply to TomD7352:

I had a comminuted calcaneum in the late 80's (in my 20's). I was told no surgery was the best option so went with it. I was putting weight on it in a week (with the help of a lot of frozen peas). Laps of the ward came quickly on crutches. Dispensed with the crutches in 10 days. It hurt after immobility i.e sitting down for long periods then getting up for a number of years. Decades later and there are no issues.

Good luck.

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TomD7352 on 21 Dec 2018
In reply to philhilo:

Did you Remeber if yours got into the joint that’s the same injury I have and mines not really displaced either.

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TomD7352 on 21 Dec 2018
In reply to TomD7352:

Thanks for all the replies. Mine is communited but all pieces are where they belong however it did get into the joint some. Slight loss to the angle but not very much at all. I was basically told in the short term the pain would be the same either way but in the long term with surgery or not I may need a fusion. Dr says otherwise few screws and maybe a plate probably wouldn’t need it. Told me I would be walking again in about 6-12 weeks with or without surgery with weight bearing and then it all depends on how my body does from there. 

 

My preference is to not have surgery I found a few studies suggesting that unless it was a severely displaced fracture that non surgical recovery was about the same as surgical recovery. One study done here and another in Canada. Both by respectable firms they both drew the same conclusions. Seems like either way down the line there’s issues.

In my experiences I’ve learned asking people that have had the same problem or similar can be more helpful. I want to be able to hike and climb again. There are worries of complications from my point of view simply because there’s about a 30% complication rate associated with this type of surgery. I can deal with some pain and I’m sure it won’t ever be 100% again. 

Appreciate anyone else that could maybe chime in if you have had similar experience. Also not necessary looking for medical advice just your experience. I know people opt different ways on this surgery quite often so I’m hoping there’s a few more people that can share there opinions.

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trouserburp - on 21 Dec 2018
In reply to TomD7352:

I had a minor fracture after falling about 5 metres, didn't even suggest surgery. Was on crutches for a while and bone was fine after about 6 weeks. Over the counter painkillers. Sprained ankles were worse and kept rolling one of them until i got a neoprene brace, wish they thought about the ankles, one of them felt weak for a year. Good luck! 

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P Gard - on 21 Dec 2018
In reply to TomD7352:

Hi Tom,

I am 18 months post a very serious calcaneum fracture (equated to a smashed crunchie bar according to the surgeon)

I would advise against surgery. my family are medics and they researched it at the time.

Be heartened about the evidence regarding calcaneum recovery and the long term prognosis. I was told I'd be lucky to walk or work again and would likely have a limp. Although I still have pain, I regularly fell run, returned to climbing and can walk long distances. 

The evidence often quoted about debilitating long term pain and impairment is mainly based on occupational injury by manual workers i.e. builders falling off ladders. The argument being there were more complex reasons for their poor outcomes due to financial payout incentives and existing comordities.

 

Siân (Paul's wife)

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TomD7352 on 21 Dec 2018
In reply to P Gard:

Thank you very much for your response. I am actually a manual laborer but I own my business and have employees etc. They make it sound like with out surgery the pain will be so intense I won’t want to live and there’s no way I will be able to walk and guarantee a bone fusion. I do have a small piece near my joint that has shifted some and has pertruded slightly into the joint and that’s the concern.  I prefer no surgery and waiting to see how it goes but then they say I could use surgery in about 6 monthis if it heals bad or wrong. I’m so concerned about it all but the alternative is 9 screws in my heal and some fake bone even though they say that will heal on its own. If you have time or read that I’d love to hear more.

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wilkesley - on 22 Dec 2018
In reply to TomD7352:

I broke mine about 30 years ago. It was completely shattered, but none of the fragments were displaced and there was only a small hairline going into the joint. When we arrived at the Hallamshire the receptionist suggested that I should go and see my GP. Luckily one of my companions was an orthopod and the other a GP!

After a night on the ward they decided not to operate as none on the fragments were displaced. I was told I could start weight bearing after three weeks, but it was still very painful. Lots of packs of frozen peas with leg raised helped to ease the pain.

It took a long time to recover properly, although I did manage to do Outside Edge wearing Koflachs after a  couple of months. The thing that took longest to recover was the reflex/muscle that gives you the spring in your step. I have slight limited ability to flex my foot laterally. It probably took more than a year to get to the stage where I could say I had recovered to as good as it was ever going to get.

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Ron Walker - on 22 Dec 2018
In reply to TomD7352:

Took a 10 metre fall soloing about 30 years ago and crushed my calcium and suspected compressed fracture of my back.

At the time I was told by the hospital I'd never climb or walk again without a limp. No surgery but several weeks in a hospital bed and then a month or two partial weight bearing. I didn't have a  permanent plaster cast but had intensive phsio with pain killers right form the start to keep joint mobility and that was key.

I was told it would take about 2 years of bone healing and remodelling to know to extent of disability and that was about right although I was winter climbing in big boots about six month later but had a few setbacks when I tried to do too much or take up running again!

I suffer slight pain after a day out and my foot swells a bit if I have too many big days but other than boulder hopping and the joint locking it doesn't really bother me much now compared to other more recent injuries and can't run on hard surfaces  

Since then I have been working as a mountaineering instructor and guide. I'm now in my early sixties so everything hurts unless I'm doing a hard lead and then I feel young again!

Post edited at 13:52
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Tony Jones on 22 Dec 2018
In reply to TomD7352:

Mine was around 1990. Initially there was talk of surgery and possible fusing but then I saw a locum who was standing in for the usual doctor and he suggested I get on with physio and start weight bearing as soon as possible. There's the odd twinge in cold, damp weather and I occasionally get a bit of pain after long walks but that's it.

Post edited at 15:03
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TomD7352 on 22 Dec 2018
In reply to TomD7352:

Thanks for more replies. How many of you guys had displaced fractures where the joint was effected. My joint has slight displacement. The surgeon didn’t even seem concerned with the rest of the heel. He says that will grow back together and fill in but the joint being not smooth and straight would be the biggest concern. The biggest bummer is even with surgery there’s no guarantees.

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AdrianC - on 22 Dec 2018
In reply to TomD7352:

A (or maybe the) fun fact about calcaneal fractures is that one type of fracture is know as the lover's fracture.  Apparently this is because it's the thing you break when you jump out of a first floor window to escape the angry spouse who has just walked through the bedroom door...

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TomD7352 on 22 Dec 2018
In reply to AdrianC:

Well I could see where it might get that name lol. 

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Andy Farnell on 22 Dec 2018
In reply to TomD7352:

I fractured my right calcaneus in October 97. No surgery (it was scheduled then cancelled), 5 months on crutches, 2 years limping and still the occasional pain when it's very cold. Didn't stop me climbing, shouldn't stop you.

As Princess Leia said ''suck it up fly boy"

Andy F

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Jaidigi on 15 Jan 2019
In reply to TomD7352:

Hi Tom, I smashed my calcaneus in to an awful lot of pieces on 14th June last year (I stopped counting at 12 pieces when I saw the images from the CT scan). All surfaces were disrupted and there was quite a bit of displacement and subluxation too.  I didn't have surgery (the surgeon quoted this paper to me https://www.bmj.com/content/349/bmj.g4483) and I went with his opinion (although to be honest he didn't really give me a choice). He said post-op complications were too high. I was 6 weeks totally non-weightbearing (with a vac cast for most of it thank goodness as that meant I could shower, and go swimming as it can get wet - although that was limited as I also damaged my shoulder in my fall).  After 6 weeks I was partially weight bearing (again in my cast - one of these https://shop.oped-uk.com/product/vacocast/ which was provided by the fracture clinic). I did my first indoor climbing on the 1st August, and outdoors on the 14th. I started leading (very carefully) a week later and soloing a couple of weeks after that (at a lot lower grade then prior to fall). All of that initially in my cast and with some very understanding and supportive climbing walls who let me on the wall even with the cast on (at my own risk). At the start of September I went up Snowdon, Lliwedd and Ben Lomond within 5 days, all on crutches and in my vac-cast.  I have some superb arm muscles from the crutches!  I did Crib Goch on my crutches (in the ice - I have little crampons for them)  When I went back to work my recovery all went backwards a bit as I was working 50-60hr weeks on my feet most of the time.  However I stopped using my cast and crutches last week (after doing Helvellyn via Striding Edge) and it is going ok.  I have pain pretty much all the time, but the intensity is getting less. I have a good range of movement in my ankle although my balance is rubbish (which I'm hoping will improve as I get out more and get used to how my ankle moves differently now - I used to feel like a mountain goat, now I fall over quite regularly if I'm caught off balance). For a while my foot was hyper-sensitive to the cold and anything slightly wonky, this is much improved now.   Luckily my foot size didn't change as can happen often, although especially from the back of my foot you can see that my ankle is now a very different shape (if that does happen there are some companies who let you buy odd-shaped shoes). On Sunday I ran 120 paces (downhill and only because I was worried I wasn't going to get back to my van before the car parking ran out. It hurt like mad so not sure I'll repeat that for a while.  The prognosis I've been given is pretty rubbish, with a 90% chance of needing a fusion or lower leg amputation within 5 years. I'm being optimistic - that is a 10% chance of not needing surgery.   I think I'd choose an amputation over fusion as I like long mountain days with a sneaky solo in the middle and whilst I've heard of a fair few people climbing with fusions, I've not heard of many people doing long mountainous walks, and you can get some amazing prosthetics! Good luck with your recovery. Feel free to message if you want any more info/encouragement. 

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Fredt on 06 Feb 2019
In reply to TomD7352:

I still haven't climbed after shattering my calcaneus three years ago. The surgery to screw it back together wrecked just about every other thing in my foot and ankle.

After a long walk, my ankle is swollen, stiff and painful for days, limping around.

So to the OP, I can't answer your question.

However, I'd like to tell everyone else how such a common and seemingly small injury can potentially put an end to your climbing, maybe your hiking and running too. I did mine with a voluntary 6 foot jump off a climb onto a flat grassy surface at Burbage North. Unfortunately my heel hit a rock that was lying just under the surface. 

The first thing the surgeon said to me was, "this is a life changer". I was sceptical, I've broken arms, legs, skull, ribs, toes and fingers and all were fully recoverable. But now I know the calcaneus is indeed the life changer.

Post edited at 09:31
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captain paranoia - on 07 Feb 2019
In reply to Fredt:

> I did mine with a voluntary 6 foot jump off a climb onto a flat grassy surface at Burbage North

I luckily escaped serious damage doing exactly the same thing at the same location. Landed on ball of right foot and heel of left. Had electric shock pains for some time, but x-ray apparently showed no fracture, and, after avoiding weighting my heel for a few weeks, it eventually returned to mostly normal. I always suspected it was a hairline crack that didn't show up on the x-ray.

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Charloam - on 07 Feb 2019

Another bit of anecdotal evidence, probably not too relevant to OP.

I fractured both of my calcaneous/heels in the summer after getting a bit too bold for my experience in the roaches, getting scared, trying to lower off a cam and not being held tight for the lower so the cam blew out a chunk of the rock above me and I landed 4 meters below on a ledge.

Couldn't weight bear but didn't realise it was fractured. Was carried back down to the car but didn't end up going to A&E til the next day.

It turned out to be a non-displaced fracture, (barely fractured on the left, mild fracture on the right). Neither made it to the joint (subtalar?).

I wore a moon boot for a month just on the right foot, crutches for a month or two and was indoor bouldering after a few weeks (to begin with not falling off at all, but then the next week started falling). I later did some tentative outdoor climbing which was increasingly fine even if my heel ached after walking for a while. After 6 months which is more or less now, I'm back to 100% as far as I can tell really. I did some scrambling a few weeks ago and I didn't even notice my foot. I've been climbing a couple times a week for a good few months now.

So I agree with people who say this type of injury can have vastly different outcomes dependent on severity. Good luck!

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Rigid Raider - on 07 Feb 2019
In reply to Charloam:

I broke my collar bone not my heel but I hope this helps: looking at the X-rays I couldn't see how the two ends could possibly meet up and heal so I asked for it to be plated but the consultant persuaded me to wait and see what happened. Two months later my shoulder was shortened and my armpit squashed shut and stinky and I was sure the bones were not uniting but in typically orthopedic consultant gung-ho fashion he poo-pooed me.  He ignored my request for an x-ray but a month later I had an episode of bad pain, went to Urgent Care and an x-ray revealed.... complete non-union. The consultant was shocked but couldn't do the plating for at least six weeks so I found another who could and did; that was 10 weeks ago and I think the second surgeon managed to wake up the dormant bone ends and persuade them to regrow into the graft materials he stuck in the gap. 

So although I understand the reluctance to operate when 85% do heal on their own, I wish I had insisted at the outset. 

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Presley Whippet on 07 Feb 2019
In reply to TomD7352:

I have suffered 2 calcaneal fractures. 

The first, hit a ledge on the way down, I should have had surgery but infection prevented it. It left me with a very deformed heel, the sharp edges of which were shaved off later. 

The second was a classic lovers heel fracture, vertical crack in the calcaneus. 

It is now 26 years since the first. I have been able to walk, run, cycle, climb fine. 3 issues:

1 blistering and ulceration, the deformed area is quite numb so blisters and ulcerated before you know it

2 general stiffness of the joint, this requiresd occasional physio but has been OK for a number of years now.

3 getting shoes to fit my deformed heel. In the early years I could not tolerate the heel cups of shoes at all so wore soft boots and backless slippers.

As for rock shoes, some fit OK, others don't. I can't really heel hook with this foot, my shoe falls off.

No problems with the lovers fracture, other than an unhappy wife. I did it on honeymoon playing daft buildering games. Oops. 

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Presley Whippet on 07 Feb 2019
In reply to TomD7352:

If you wish to discuss further pm your phone number. 

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Steve27 - on 08 Feb 2019
In reply to TomD7352:

So it's been a month since your post. What did you opt for and how's it going?

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Deadeye - on 09 Feb 2019
In reply to TomD7352:

As a general rule of thumb, if the surgeons are saying non surgery has similar outcomes to surgery then choose the lowest intervention route. Pain is an outcome. So is mobility, infection, surgical complications etc.

From the little you've told us I'd leave alone 

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