Calcaneous fracture... decision to not have surgery pending - Foot Problems Message Board

seaman · 06-21-2008, 12:35 PM

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?

tchair · 06-22-2008, 02:55 AM

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.

seaman · 06-22-2008, 10:32 AM

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.

tchair · 06-23-2008, 03:14 AM

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

seaman · 06-26-2008, 01:52 AM

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.