It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Foot & Ankle Problems Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 06-21-2008, 11:35 AM   #1
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Calcaneous fracture... decision to not have surgery pending

I fell on June 8th and broke my heel bone. The day I hurt my foot, my wife drove me to the emergency room as I was in a lot of pain. The emergency room took x–rays and the doctor told me it was only a sprain and I would be walking in 2-3 days. They reviewed the x-rays on the spot and made this diagnoses. An hour after I left, another x-ray doctor reviewed my x-rays and detected a possible fracture in my heel. They never contacted us about this new diagnoses and it was over a week later that I had my follow-up with my PCP. On the way to my appointment with my PCP, we had the foresight to pickup the x-rays and there was a note included from the 2nd x-ray doctor referring to the fracture... first time we knew something was amiss. I have since had new x-rays and a CT scan to see the full picture.
The specialist I went to wants me to have surgery to repair the bone. I asked him what would happen without surgery and he said it would be better with surgery, but could not give any convincing arguments. I am leaning towards no surgery as he said I may eventually have to have the bones fused in either case. I also have this statement from the x-ray doctor who reviewed my second round of x-rays:

Findings:
There is a fracture involving the body of the calcaneous. The fracture fragments are near anatomic alignment. Anterior and posterior calcaneal spurs are present.

Impression:
1. Fracture seen through the mid body of the calcaneous. The fracture fragments are near anatomic alignment.
2. Minimal degenerative changes are present as described above.


I have read some of the horror stories about post surgery healing and I'm thinking I may be better off without it. Fortunately, my job is very sedentary and no surgery almost guarantees my return to the workforce sooner. What I don't want to happen is find out that I have turned a bad situation into a permanent disabilty by skipping surgery. Any thoughts?

Last edited by seaman; 06-21-2008 at 01:39 PM.

 
Sponsors Lightbulb
   
Old 06-22-2008, 01:55 AM   #2
Senior Member
(male)
 
Join Date: Nov 2000
Location: USA
Posts: 241
tchair HB Usertchair HB Usertchair HB Usertchair HB User
Re: Calcaneous fracture... decision to not have surgery pending

seaman,

I'm not a doc but my understanding is that the main reasons for surgery are displaced fragments (measured in millimeters) and a depressed arch (Measured in degrees: Boehler's angle), either of which can prevent you from walking normally. You have a big decision to make. You need specifics. The docs should not expect you to know what to ask. They should not place the responsibility of the decision on you without full disclosure in terms that you can understand. If the two docs do not agree and they cannot give you what you need to make an informed decision get another opinion. It is not at all unusual in this case, it can be a life altering injury.

I had the ORIF surgery, but I am in no way a proponent. Any surgery involves risks and this involves an area of not only bones and joints but important nerves and tendons. So the procedure must be well justified. But, I believe that the 'horror stories' may be more related to the severity if the initial injury, for instance with major displacement of bones requiring surgical fixation would you would expect a high degree of nerve and tissue damage.

Returning to work can be done to soon. As far as recovery goes I think the more you go for and the sooner the better, even if it means needing full days to recover. But with work it is a different story. When you think you are ready you might be 90%, but that 10% can get you. That's when a quick unexpected stop hurts a lot, that night when you got no sleep or that morning when your foot is so stiff that you can't walk. When we go back to work people have no idea of the long recovery time for this injury. Many have broken bones and come in the next day in a cast. Bosses often don't care and want 100% period, no excuses. I strongly recommend that you be over prepared for your return. Make sure your foot has been through all of the paces especially any bad ones. Work and being productive are important to us. When timing you return think in terms of a balance between rushing and having it a success.

Finally my favorite. I know 347 Heelies who were told they might need fusion. I know of 6 or 10 who have had it. It's in the literature that the docs read so they parrot it to you. Maybe it's to be covered in case you turn out to need it later. Even then later is fine, has no effect on the outcome.

 
Old 06-22-2008, 09:32 AM   #3
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

Thanks Tchair for your reply. Unfortunately, one of my prime reasons for not wanting surgery is that I can't afford a 6 month recovery. I am self-employed with no disability ins. If I'm out of work for 3 months it hurts a bit... 6 months and I have no house. I don't want to sacrifice my future health for a quicker recovery, but what choice do I have? I will have a 3rd opinion from another doc tomorrow and I will ask him to prove to me that surgery is the best option.

 
Old 06-23-2008, 02:14 AM   #4
Senior Member
(male)
 
Join Date: Nov 2000
Location: USA
Posts: 241
tchair HB Usertchair HB Usertchair HB Usertchair HB User
Re: Calcaneous fracture... decision to not have surgery pending

seaman,

It's not so much future health as prolonging recovery. When back to walking you can make other joints ache by favoring the foot. You'll limp at first and the cure is to take the time to use long slow strides. Even at that point continuing range of motion exercises is a good idea. Like anything you would want to get good at, working at it part time won't stop you from getting there, it will just take longer. Let us know how the appointment goes.

TC

 
Old 06-26-2008, 12:52 AM   #5
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

The 3rd doctor (and 2nd specialist in foot injuries) to review my CT scan and x-rays said that surgery could help, but wasn't necessary. When I returned to my original specialist he actually said that after looking at the CT scan, surgery was not going to significantly change the outcome. I now have a strap-on boot that I will (hopefully) be walking in by July 12th. My doctor wants me to wear the boot as much as possible, but to also flex the joints often.

 
Old 06-27-2008, 02:25 AM   #6
Newbie
(female)
 
Join Date: May 2008
Location: sandiego ca
Posts: 3
annie66 HB User
Re: Calcaneous fracture... decision to not have surgery pending

2006 severe fracture and depressed subtalar joint. had surgury,9 sccrews and 1 plate , infection happend, they tried to manage it ,didnt happen ,(ill fitted hardware) wore my my flesh from from the inside out and had no choice but to remove hardware from my foot. Mind you ,i have had 3 surgeys and not doing well at all. lost my job and everything in between, still waiting ssi ( however ,my fooooot is f up ) my last ev was to fuise ankle ,remove scar tissue,remove sural nerve, and cut /stretch achellies tendon

 
Old 06-28-2008, 01:41 AM   #7
Senior Member
(male)
 
Join Date: Nov 2000
Location: USA
Posts: 241
tchair HB Usertchair HB Usertchair HB Usertchair HB User
Re: Calcaneous fracture... decision to not have surgery pending

Annie,

Just wondering, was your break caused by a motor vehicle accident ? Before proposing fusion have you had x-rays and CT scans or MRI's? They really should be able to show you arthritis or other joint damage or that justifies the procedure. The foot with it's tightly crowded components doesn't take well to scar tissue. The tendons have to slip and slide a lot to work well. It doesn't help that the nerves run right along with them and there's there's no nice fatty tissue between. My understanding is that extensive physical therapy by an expert in this area is the first option to try for breaking up scar tissue. The shortened Achilles tendon could be a result of the initial injury or having it shrink due to disuse. Have they explained which is the cause and why they have not treated or prevented it earlier? Finally, make sure you heard right on the sural nerve. If it is entrapped or has developed a neuroma the least risky surgery is to "move" it to where it will be less effected. "Removing" it is a very drastic desperate choice. The results from nerve ablation (through cutting, freezing, or chemical s) range from none, to temporary to worse than before it was done. Before considering it I would try every alternative treatment from medications to acupuncture and then talk to a surgeon who's specialty is treating patients who's nerves have been severed. You're at the far end of the spectrum with serious long term complications. Do everything you can to research, seek out experts, learn as much as you can. You would be surprised how many docs are in their own little niches. I learned the hard way that foot doctors don't necessarily know about pain management, neurology, medications or many other important areas. Be sure that you do rather than letting them shoot from the hip into those areas.

Seaman,

As a rule - with or without surgery - the non-weight bearing period is 12 weeks. There have been a very few exceptions. I'll bet that the doc said something along the lines of "We'll see about walking at your next appointment." If you go in and he then says "Let's give it a few more weeks then see me.", don't be disappointed. If he says to start partial weight bearing, consider yourself one of a very fortunate few. In addition to ROM (range of motion), give attention to circulation and stamina. You need good circulation to speed healing and prevent the leg from aching and even more so if you will be sedentary. You will want to do leg lifts and a lot of them. you will want to exert yourself now so that just getting up and down doesn't seem like a chore later.

TC

 
Old 07-19-2008, 09:14 AM   #8
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

Update on my progress.

Saw my doc Friday and he took x-rays on my heel. He told me I could put weight on it while wearing my boot and he expects me to be crutch-free in 3 weeks (my next appointment). It hurts a bit to put weight on my foot, but it mostly seems to be ankle pain. I can put my full weight on it for very brief periods and I'm sure I will meet my doc's expectations. I'm wondering if my ankle has still got its own issues and my heel is actually doing quite well.

Who has some insight on what to expect when first starting to walk again?

 
Old 07-22-2008, 05:15 AM   #9
Senior Member
(male)
 
Join Date: Nov 2000
Location: USA
Posts: 241
tchair HB Usertchair HB Usertchair HB Usertchair HB User
Re: Calcaneous fracture... decision to not have surgery pending

seaman,

About the ankle, every Heelie asks that same question. I think it is because that's the part that smashed into the heel, there are all those tendons running through it that you're trying to use again and since ankles do the biggest job so are the weakest link until healed. As for starting to walk I'd expect better luck with short frequent sessions as opposed to long stints.

TC

 
Old 07-22-2008, 01:37 PM   #10
Senior Member
(female)
 
Join Date: Jun 2008
Location: UK
Posts: 240
patw27 HB User
Re: Calcaneous fracture... decision to not have surgery pending

Hi Seaman,
I broke my heel on 28th. Feb.no surgery, nwb for 12 weeks, partial wb as tolerated for another 6 weeks during which time I started PT with theraband.You will feel like all heelies that it will never improve but trust me it will given time.I was in wheelchair when going out until last week when I was able to use elbow crutches for the first time to go around the shopping centre, it was very slow but I felt so good!!! I expected to have pain the following day but foot was great and I thought that I would return to work this week. My foot seemed to go from very painful to painfree over night so I decided to walkaround the house without aid as much as possible --- boy was that a wrong move!!! Foot quite painful again and when I went to PT today was told not to try walking yet but use one crutch instead as all I am doing is limping not walking, I am starting hydrotherapy next week to aid the walking process and have been told that I will only be able to return to work if I can sit down all day so will leave it a little longer.
When you do start to walk it can feel fine for a while and then the ankle or some other foot part that didn't hurt before will now hurt and swell up but that is normal. I have had no walking boot or aircast but my ROM is much improved with using theraband and I am much happier now than I was a few weeks ago as I can see the light at the end of the tunnel

 
Old 07-23-2008, 04:40 PM   #11
Junior Member
(female)
 
Join Date: Mar 2008
Location: San Antonio, Texas, USA
Posts: 47
Caroline777 HB User
Re: Calcaneous fracture... decision to not have surgery pending

Hi Seaman,

Thought I'd reply to one of your earlier post, "insight on what to expect when first starting to walk again?" Here's my story:

January 28th slipped off a ladder and broke my right heel into 4 pieces, also fractured my talus. I had the usual 12 week NWB; I unfortunately could not start physical therapy till the 12th week because of swelling. For a while my orthopedic thought that I had damaged my nerves and may need surgery to repair, the reason he thought that is because every time he touch the bottom of my foot it caused a lot of pain. It turned out to that my nerves were being aggravated due to the swelling. I had no permanent damage I just had to work on the swelling and remarkably at about 12 weeks it got better. When I went to see my orthopedic he told me to “lose” the crutches and start walking. Now I thought he had lost his mind I was not about to just “start walking”. I went out and bought a good pair of running shoes, a pair that provided a lot of cushion to my heel. I then started walking but using my crutches, by using the crutches I only put partial weight on my foot. You will know how much weight to put on your foot. I walked like that for about 2-3 weeks, during that third week I would walk short distances with just one crutch to see how it felt. I then went down to one crutch; I did that for about another 2-3 weeks. During that third week I started walking short distances without the crutch. It was very slow at first. Oh I forgot to mention that when I started the partial weight bearing I did not feel any pain whatsoever on my heel, my ankle felt sore but not painful. I also started PT at 12 weeks, which really, really helped out a lot.
It has now been almost 6 months, I am walking really well. I am no longer in PT but I still work my foot and leg out every day. I walk my treadmill every other day and once a month I jog for all of 1 minute. I feel absolutely no pain while walking or jogging. I also started riding my bike and that has helped to strengthen my leg which had weakened very much from the NWB weeks. Muscle atrophy set in something awful on my right leg, especially my calf. Here are some istakes that I have made and paid for it in pain, recently I started picking up the pace on my walk and I really should not have done that. Since I started walking faster, I stopped walking the whole step through and as a result my knee started hurting. I’ve had to slow down again and that has helped with the knee pain. Once you start walking you have to really think about how you are making each and every step. You will know how much weight to put on your foot and when you are ready to add more weight no one can answer that question for you, you will just know. It’s amazing how your foot forgets how to walk, plus throw in there the fear that all of us have with putting weight on our hurt foot. I use to have screaming nightmares about putting weight on my hurt foot!

It has been a long road but everyday it gets better. Just take it slow, learn to read your body.
Good luck
Till next time…
Caroline
__________________
Caroline777

 
The Following User Says Thank You to Caroline777 For This Useful Post:
Carbonfiber139 (07-05-2012)
Old 07-27-2008, 04:37 AM   #12
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

Thanks to everyone for your input on how to start walking again. This is exactly what I needed to hear. The comment about ankle pain was the most useful to me, because that is what I was most worried about. My heel doesn't seem to hurt much, but my ankle and achilles tendon seem to hurt quite a bit. I think my fracture must have been minimal compared to most people's, but my worry was equal if not greater. As I said earlier, my doc told me that after my 6 weeks with no weight at all, he wants me to be walking crutchless within 3 weeks. About the 3rd day after I started putting weight on my boot, I was able to go crutchless for a very short stints. I'm now trying a day of full weight with no crutches (maybe 30-60 minutes of walking spread over 8 hours) and then a day of no weight, because my ankle gets sore and it just hurts too much. I'm sorta looking at it like a body builder would, the days off are required to let the joints recover. Anyone think this is a good regime?

Last edited by seaman; 07-29-2008 at 10:46 PM.

 
Old 08-12-2008, 10:50 AM   #13
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

Well, it's been over 2 months since I fall down and go boom. My not getting surgery seems to be paying off, at least in the short term. I can now walk (limp?) without crutches and without my 'ski' boot. I can stand flat-footed with all my weight on my 'bad' foot. I walk with only a little ankle pain, but don't feel confident enough to try to walk heel-to-toe (normally) with my bad foot and treat it mostly like a stump. I'm guessing as the pain disappates even further I will start flexing the ankle when I walk.

I still feel I'm in the minority as far as damage to my calcaneous and ankle go, and I'm not trying to gloat, but I was so concerned after reading some of the worst examples of heel bone problems that I assumed I was in the same boat.

 
Old 09-09-2009, 02:12 PM   #14
Newbie
(male)
 
Join Date: Jun 2008
Location: Houston, TX
Posts: 8
seaman HB User
Re: Calcaneous fracture... decision to not have surgery pending

This is a weird injury isn't it? A year later and I have finally had a day without pain when I walked normally. I can walk normally sometimes although usually it hurts when I do it. I was wondering if I would ever walk without limping. I think I see the light at the end of the tunnel. My leg muscle is still not as large as the other leg, and I have been exercising very little. If I had done regular workouts I'm sure I would have been back to 99% 6 months ago.

 
Old 09-10-2009, 02:27 PM   #15
Senior Member
(male)
 
Join Date: Nov 2000
Location: USA
Posts: 241
tchair HB Usertchair HB Usertchair HB Usertchair HB User
Re: Calcaneous fracture... decision to not have surgery pending

Hey Seaman,
Good of you to give an update. I'm also sure that what you say is correct. Working that foot and leg can be as simple as having it do an equal share. Walking right is doable if you can make yourself to slow down your pace. I think I'm going to market a new product. It will be a shoe with a tack in it for the GOOD foot to force heelies to put the proper demands on the injured one.

Tim

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Calcaneous fracture complications Gperet Foot & Ankle Problems 3 11-24-2010 05:58 AM
Calcaneous surgery - Recovery and what to expect? pinachui Foot & Ankle Problems 54 08-21-2010 05:44 PM
Calcaneous fracture guy2009 Foot & Ankle Problems 7 06-15-2009 01:12 PM
Fractured Calcaneous 5 triguy450 Foot & Ankle Problems 111 11-01-2008 01:51 PM
Fractured Calcaneous 4 Hyper86 Foot & Ankle Problems 79 10-21-2008 06:02 AM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



roxygirl1 (187), Zerk (133), Titchou (129), Missyluke (121), Hollywood48 (118), ginger62 (97), LadyKanner (97), LisaBdot (83), AdkLizard46 (55), janewhite1 (52)

Site Wide Totals

teteri66 (1164), MSJayhawk (997), Apollo123 (898), Titchou (832), janewhite1 (823), Gabriel (758), ladybud (745), sammy64 (666), midwest1 (665), BlueSkies14 (610)



All times are GMT -7. The time now is 01:34 AM.



Site owned and operated by HealthBoards.com™
Terms of Use © 1998-2014 HealthBoards.com™ All rights reserved.
Do not copy or redistribute in any form!