Treatment of Closed Calcaneus Fracture With No Significant Displacement and No Subtalar Joint Involvement
This protocol targets a specific clinical presentation: a closed calcaneus (heel bone) fracture with no significant displacement of fragments and no intra-articular involvement of the subtalar joint — a pattern that may be amenable to non-surgical management.
Clinical scenario
The fracture is closed, with an intact skin surface that reduces infection risk compared to open injuries. Fragments are not significantly displaced. The subtalar joint is not involved, classifying this as an extra-articular injury — a distinction that may influence the choice between surgical and non-surgical approaches.
Approach (partial overview)
Management centres on conservative, non-surgical care — with mechanical protection of the foot and physical measures for swelling control as the foundation; the full sequence of interventions, analgesic selection criteria, and supporting details are contained in the structured protocol.
Treatment goals
- Resolution of heel pain
- Resolution of heel and foot swelling
- Calcaneal fracture healing confirmed on radiograph
References
DOI: 10.7759/cureus.54786
- Extra-articular fractures, in contrast, do not involve the subtalar joint and typically affect the body or process of the calcaneus.
- The absence of joint involvement may influence treatment choice, with non-surgical approaches being more feasible in some instances.
- Closed fractures are characterised by an intact skin surface, reducing the risk of infection compared to open fractures.
- Rest is the cornerstone of the initial management of calcaneal fractures, aiming to minimise weight-bearing on the affected foot.
- Immobilisation, often achieved through the use of crutches or a brace, serves to prevent further trauma to the injured area.
- Applying ice packs to the affected area in 20-minute intervals helps constrict blood vessels, reducing blood flow to the injured site and alleviating pain.
- Compression controls swelling and supports the injured foot.
- Elevating the foot above heart level, especially during rest periods, is a simple yet effective measure to minimise swelling associated with calcaneal fractures.
- Medications such as ibuprofen or naproxen are often prescribed to alleviate pain by inhibiting the production of prostaglandins, which contribute to pain and inflammation.
- Analgesics, including acetaminophen, are employed for pain control in individuals with calcaneal fractures, particularly in cases where NSAIDs may be contraindicated or not well-tolerated.
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