The Center for Podiatric Care and Sports Medicine

Heel Fracture Treatment and the Risk of Arthritis After Surgery

Posted by on Friday, August 10th, 2018


Here at The Center for Podiatric Care and Sports Medicine, a heel fracture is referred to as a “calcaneal fracture.” We most commonly see this type of fracture resulting from a car accident or a fall from a ladder. However, we’ve also diagnosed calcaneal stress fractures in long-distance runners, ballet dancers, and athletes who participate in sports involving jumping. Calcaneal injuries continue to be one of the most complex in podiatry, and there is no widely accepted consensus on the best way to manage heel fracture treatment and avoid complications, though it is an area of considerable research.

heel fracture treatment
Subtalar arthrodesis is a common approach to calcaneal fracture, but will you develop post-traumatic arthritis? [Image Source:]

Heel Fracture Treatment: Subtalar Arthrodesis

You can think of the heel bone as an egg—with a hard exterior and soft interior. When the “shell” shatters in an accident, multiple fractured pieces must be reassembled and the subtalar joint must be restored sufficiently enough to bear the bulk of a person’s body weight again.

Subtalar arthrodesis involves removing the damaged joint and cartilage remnants and directly fixing the lower calcaneus bone with the upper talus bone using screws and additional bone grafts if necessary. The surgery is typically done as an outpatient procedure in less than three hours, using general anesthesia with a nerve block. High-risk patients may need to stay in the hospital overnight.

When the subtalar joint is fused, the foot loses side-to-side motion—which most people have lost due to injury already. Navigating uneven surfaces can be a challenge after arthrodesis, but most patients agree the pain relief is well worth any limitations to the full range of motion they may experience afterward. Following fusion surgery, adult athletes are able to participate in recreational sports activities. Children, in particular, seem resilient in returning to sports after surgery.

Recovery from arthrodesis surgery is substantial. Two months in a cast with crutches can be expected, followed by another month in a walking boot. It takes three months for the bones to heal and fuse together, four to six months for the soreness to subside, and up to a year for all swelling to diminish. Stationary cycling, while wearing a cast for protection, can begin as early as six weeks after surgery.

Post-Traumatic Arthritis: The Most Common Complication

An injured joint is roughly seven times more likely to become arthritic compared to a non-injured joint. Even injuries treated to the gold standard can develop arthritis for reasons that continue to mystify researchers. One theory is that the body secretes a hormone that triggers the death of cartilage cells. What we do know about post-traumatic arthritis is that it tends to occur in cases where healing schedules are sub-optimal. The silver lining is that nearly half the patients with clinical evidence of arthritis will not be symptomatic or feel limited in their abilities as a result. Very few people will require specialized shoes or ongoing care. Even so, you don’t want to be one of the anomalies who ends up with moderate-to-severe levels of daily pain requiring additional surgeries. So what can you do?

Will You Develop Posttraumatic Arthritis After Calcaneal Fracture?

Harvard Medical School recently completed a retrospective study of the risk factors for developing arthritis following subtalar arthrodesis for 84 patients from 2001-2016. They found that, in general, the quality of life among patients was significantly lower compared to the general population, but were acceptable by medical standards.

Among all variables, smoking was most heavily correlated with worse outcomes. Patients who suffer immediate complications from the surgery were most at-risk for developing arthritis years down the road.

Complications of heel fusion surgery typically include:

  • High-energy trauma
  • Implant failure
  • Infection
  • Ipsilateral (knee) injury
  • Nonunion

Heel Fracture Treatment in NYC

For you, as a patient, the best you can do is be careful. Take the necessary precautions to not get hurt again. Also, abstain from smoking, which delays bone growth and wound healing significantly, resulting in non-union. Another factor in arthritis development is atrophy after certain structures fall into disuse. For this reason, we advocate an “active recovery” as much as possible. We recommend walking boots to casts and gentle activities like rehabilitative manipulation, cycling, swimming, and rowing as soon as you can manage it. Contact one of our board-certified podiatric surgeons to receive progressive treatment for a heel fracture.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.