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Old 10-14-2009, 05:25 AM   #1
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goatboy011 HB User
Unhappy Calcaneus - surgery or not?

Hi Heelies,

Shattered my calcaneus falling from ladder last week. Doctor wants to schedule me for surgery, seems to be conventional wisdom. What worries me (uninsured) aside from cost is the invasiveness of surgery, infection, complications in healing, later complications with hardware installed, more surgeries... It sounds like there will be same problems later in life regardless of surgery... How debilitated should I expect to be in the short term should I not do surgery?

Anyone opted not to have surgery and have any input for me? Anyone had the surgery and wish they didn't? Everyone says I should have the surgery, but it's not their heel and they are not paying the bill :-) Thanks.

Last edited by goatboy011; 10-14-2009 at 07:24 AM. Reason: Expanding question

 
Old 10-16-2009, 08:20 AM   #2
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Re: Calcaneus - surgery or not?

goatboy011,

Let's use a car tire as a metaphor. You get a flat and need to know if a new tire is in order. It could be a small hole, a rim or valve leak all which have easy fixes. It could be that the tire is too old or has a tear in the sidewall and it has to come off. Most often it's cut and dry with the answer quite obvious. Occasionally there's the 'iffy' situation when the hole's not too big or the tire's fairly worn and you have to make a decision.

In the same way it might be obvious to the docs that pieces of bone out of place that need to be realigned, it's just a crack that will heal fine or it could be somewhere in the middle.

The doctors recommend for or against surgery with the goal of minimizing long term problems. One thing to keep in mind is that rather than the surgeries resulting in more problems, more likely the injury is the cause and the ‘repairs’ do more good than harm. That's what you want explained by the doc so you are making an informed decision.

The most common reasons requiring surgery are: an intra-articular fracture meaning it reaches the joint, the bone fragments are displaced and will not readily rejoin, they are malaligned and will not heal in the proper position. There is also the "Boehler's angle" which is the position of the calcaneus in maintaining the foot's arch. Another term is "comminuted" a lot of small pieces, but that's pretty much standard with this break from a fall. Commonly used methods used to classify this fracture are: "Rowes" and "Sander's" and "Essex Lopresti".

Other considerations would soft tissue damage tendons, nerves, and blood vessels. Also your age, general health and habits (Re: smoking).

You get to look up all these terms, get some idea of what they mean. Once you've done your homework you can ask your doc to explain why surgery is necessary without getting answers that are too simplistic or over your head.

A good doc will ensure that you understand the reasoning for any surgery. A good doc will be happy to have you get a second opinion. Note: You can expect a direct correlation between their willingness to answer questions to your satisfaction now and the proficiency and the care they provide in the future.

I very highly recommend that you write your questions in advance. It will let you get to and stick to them in the brief time you will have available. I even more highly recommend that you bring along an advocate. They have a dual role. One is to make sure that you ask and listen, the other is to make sure the doc responds properly. You can be quite tense and anxious while the doc might be in a hurry (or in worst cases disinterested). Your advocate needs no special qualifications, except to understand and accept their role in advance.

Tim

 
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