A variety of foot problems can lead to adult acquired flatfoot deformity (AAFD), a condition that results in a fallen arch with the foot pointed outward.
Most people — no matter what the cause of their flatfoot — can be helped with orthotics and braces. In patients who have tried orthotics and braces without any relief, surgery can be a very effective way to help with the pain and deformity.
Adult acquired flatfoot is one of the most common problems affecting the foot and ankle. Treatment ranges from nonsurgical methods — such as orthotics and braces — to surgery. Your Wisconsin Bone & Joint doctor will create a treatment plan for you based on what is causing your AAFD.
The calcaneus can be injured in a fall, twisting injury, or motor vehicle collision. A simple twisting injury may result in the calcaneus being cracked. The force of a head-on car collision may result in the bone being shattered (comminuted fracture).
Different causes can result in similar fracture patterns. For example, when landing on your feet from a fall, your body’s weight is directed downward. It drives the talus bone down into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus. In both cases, the resulting fracture patterns are similar. The greater the impact, the more the calcaneus is damaged.
The most common symptoms of a calcaneus fracture are:
- Heel deformity
- Inability to put weight on the heel or walk
In some minor calcaneus fractures, the pain is not enough to stop you from walking, but you may limp. This is because when you walk, the Achilles tendon acts through the calcaneus to support your body weight. If the calcaneus is deformed following an injury, the muscle and tendon cannot generate enough power to support your weight. Your foot and ankle will feel unstable, and you will walk differently.
In planning your treatment, your doctor will consider several things, including:
- The cause of your injury
- Your overall health
- The severity of your injury
- The extent of soft tissue damage
Because most calcaneus fractures cause the bone to widen, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better overall outcomes. Recreating normal anatomy, however, most often involves surgery. Surgery is associated with a higher risk of complications.
Your doctor will discuss the treatment options with you.
If the pieces of broken bone have not been displaced by the force of the injury, you may not need surgery. Casting or some other form of immobilization may be an option. This will keep the broken ends in proper position while they heal.
You will not be able to put any weight on your foot until the bone is completely healed. This may take 6 to 8 weeks, and perhaps longer.
If the bones have shifted out of place (displaced), you may need surgery.
If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your leg immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.
This waiting period before the operation often improves your overall recovery from surgery and decreases your risk of infection.
Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery.
Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon tears away from the bone (avulsion). For this type of fracture, early surgery can decrease the risk of injury to the skin around the Achilles tendon.
The following procedures are used for various types of calcaneus fractures.
Open Reduction and Internal Fixation
During this operation, the bone fragments are first repositioned (reduced) into their normal alignment. They are held together with special screws or metal plates and screws.
Percutaneous Screw Fixation
Sometimes, if the bone pieces are large, they can be moved back into place by either pushing or pulling on them without making a large incision. Special screws can be placed through small incisions to hold your bone pieces together.