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jfarrell 06-17-2004 07:54 AM

Fractured Calcaneus
Hi folks:

March 7th I suffered compound fracture from a fall. I had two surgeries immediately, closing the wound and installing two external screws. Screws were removed at six weeks, I began PT imediately - spending 4 more weeks in a boot NWB, then totally to tolerance after that.

It is now almost 14 weeks into process. I hope to get a better understanding of my outlook from folks on the board. I have what I consider moderate to sever pain as I walk with a severe limp. I believe that the flattened calcaneus is impinging my outside tendons (pereoneal?) which is causing a great deal of pain. The swelling is still bad, much worse as the day wears on. I have large degree of numbness to the exterior of my heel.

My doc has advised waiting at least six months total before seeing another specialist (he said he cannot do any further work, which I appreciate).

I echo everyone else's comments, this injury is a nightmare. I have been an athelete all my life and I have never had to recover so slowly. (37 yrs old)
Anyone at the 12-24 month mark in recovery, I would appreciate hearing when I will reach the 'as good as it gets' mark so I can gauge meeting with another doctor for possible alternative measures.

Thanks so much and best of luck to everyone.


mwagner 06-18-2004 10:36 AM

Re: Fractured Calcaneus
I am 47 years old and broke my right calcaneous in a fall on Sep 6, 2003. I had a plate and 10 screws implanted to repair the bone, which has occurred.

However, pain is still with me. I had surgey last week to remove the hardware which went well. But, when the doctor used the scope to scape scar tissue, he noticed about 30% of cartiledge damage on the sub tailor joint. He claims this is the cause of most of the pain and is know recommending a sub tailer fusion with the heel.

I have basically been in pain and limping for 9 months now with more work to be done.

Can anyone shed some optomism on this situation?

I wish you well with your recovery. How did it happen?

jfarrell 06-21-2004 08:14 AM

Re: Fractured Calcaneus
Thanks for the message. We are building a new home - in March I was in the house and fell through the first floor (hole for basement stairs) and my foot hit the bottom rung of a ladder that was in the space. I was lucky, it was dark and could not prepare to land - thank goodness the concrete floor had not yet been poured.

I am sorry to hear you are still in pain. I have sharp pain and swelling around the outside/rear of my ankle. I believe the Pereonetal (sp?) tendons on the outside of my foot are being pinched by the regrown bone. The pain has not changed in the last couple of weeks and I am fearful that this is 'as good as it gets'. My doc, who is a trauma specialist, has recommended seeing another orth. doc at the 6 month point which will be August/Sept. I have a 3 year old boy and an 8 year old daughter (who was extremely disappointed that we could not have our yearly father's day camp out this weekend due to omy discomfort) and I need to make a strong recovery for their sake.

Where exactly in your foot is the pain you feel, and how did you feel about physical therapy?

I look forward to hearing from you again.



tchair 06-21-2004 09:14 AM

Re: Fractured Calcaneus
Hi J and M,

My fractured calcaneous was eight years ago with eight screws. I was offered fusion but since my doc said there was no need to hurry that I asked for less invasive treatment. Since the bottom of my heel was no longer level I was sent to get a soft foam orthodic molded for my foot. That alone took care of so much pain that I never needed the fusion. I wear the orthodic everywhere except the shower. Maybe you could try that route first.
In my opinion it takes a year just for the majority of healing. Then another year getting things to work smoothly. I think all the bones, joints and tendons take a beating from the impact and being interdependent they have to wait their turn to heal.

jfarrell 06-21-2004 12:12 PM

Re: Fractured Calcaneus

Thank you for the input. I have noticed that I am walking very much on the outside of my foot as I limp to avoid the pain. Did you experience anything similar? Also, do you have suggestions regarding the timing of a possible next procedure that you learned from your doc? I will be patient if that is all it will take, however, I am concerned that I may let a window of opportunity close if I do not act at the proper time.

As far a pain goes, did you use medication, did you limp severely? Also, was your heel/ankle disfigured permanently?

Thank you for your help.


mwagner 06-21-2004 04:32 PM

Re: Fractured Calcaneus
Joe and T - My heel pain (right foot) is mostly on the right side where the plate and screws were installed. However, I also get some ankle pain and severe sharp shooting pains all over the foot. I have no idea what causes this and it happens even with no weight bearing. The sharp pains have subsided recently which I am very thankful for. I am on crutches now (12 days after latest surgery when the Dr removed my hardware). I cannot put much weight on it yet.

Lets keep talking - maybe update each other weekly?


tchair 06-22-2004 06:10 AM

Re: Fractured Calcaneus

I had a complication where the EMT that was "immobilizing" my leg drove a piece of bone into the Sural nerve. That pain was worse than the original break and took an implanted nerve stimulator to treat. That aside you have to figure that the force that broke the calcaneous also knocked other bones loose (and into each other). Plus tendons and other tissues where injured. So unlike say a broken leg, Theresa a lot of healing needed. The swelling goes down gradually after months. Parts that got stretched have to tighten up and the bones just plain don't work right until that happens. For the first few months I only shuffled. Then I walked always placing my foot flat. It was more months before I could push off with my forefoot. I think it's really early in the process for you. You absolutely have to use your foot, get your muscles in tone and circulation active by getting around anyway you can. But things won't work right unless you use them right. I found that I had to make a conscious effort to walk as 'correctly' as I could manage. It was sort of like doing push-ups, I had to practice and build up to it gradually. It would be really smart to do leg exercises like lying down and using ankle weights. Your Doc or physical therapist should have given you 'range of motion' excursuses for your foot.

Your next procedure should be just healing time. At three months it's much better than at 14 weeks, then you get to six months and the first three are history. I will mention that three or four docs said that I would have serious arthritis within two years and it's been four times that long and no sign of it.

I did take a lot of medication for the nerve damage and for over five years, none now. I would not be hesitant to ask for relief from the pain. If at three months it's still a major problem, have it treated by a pain specialist.

jfarrell 06-24-2004 11:59 AM

Re: Fractured Calcaneus
T, & troops

Thank you for the encouragement and valuable info. I am working hard to use my foot 'correctly' to force things to work right. I will see my doc again in 1 month for an x-ray to ensure that the bone has healed. I suppose after that I will continue PT until I am satisfied to just work on it on my own. It's good to hear that you have done so well. I believe staying active will ward off the arthritis, though I was told the same thing.

Have you had experience with pain specialists? What exactly do they do differently than the orthopedic gang? I am using advil and tylenol till early afternoon, from 3-10 I take 2 vicodin and this seems to work out now.

tchair 06-25-2004 01:03 AM

Re: Fractured Calcaneus
Joe, I know by 'force' you mean to be persistently conscious to try, not to hurt yourself, right? After six months I quit PT so I could get back to work full time. That was a mistake. I had a limp for many more months (which began to effect my knees and hip) that the guidance of continued PT would have resolved sooner.

With just the fracture I would have needed Vicodins to get through the PT. Better to take pain killers than get miserable with or miss PT. Do tell your doc about any pain, how much and how it effects your abilities. Do say if you need relief. Don't give the wrong impression by over simplifying it to "I need more pills." Doctors often use a 'pain scale' and ask: "With 0 being no pain and 10 being the worst you've ever felt, what is it now and on average?" First be honest don't exaggerate or worse understate the pain. You will see where people proffer their own ideas of what each number on the scale is. The docs ignore this. The scale is not for treatment and not exact, but to later gauge the effectiveness of treatment.

I found my surgeon had little regard for my pain, only that the bones had healed. A pain specialist concentrates on treating pain and is only concerned with the underlying cause as it applies to that. The generally accepted definition of chronic pain is: "pain that persists for more than three months or that outlasts the usual healing process. Some authors choose six months as the cut off". My surgeon's waiting a year to send me to a pain management clinic was far too long. You have to factor in that your injury is on the long end of the healing process scale. Also the PT will smart because your foot and ankle will be in rough shape from disuse.

From your earlier post, my foot looks fine. The swelling to a year to go down completely the scar is hard to notice.

jfarrell 06-25-2004 07:18 AM

Re: Fractured Calcaneus

I did mean 'consciously try', not injure myself in some way. Frankly I don't honestly believe I have enough tolerance to cause damage before the pain makes me stop! When you said "With just the fracture I would have needed Vicodins to get through the PT." what exactly did this mean? Are you saying that because of the other complications, more medication was needed? (also, from your earlier post, did you indicate taking med's for 5 years?)

I don't want to harp on the pain medicine thing but, frankly, it seems that many in the medical community are so eager to stop prescribing the stuff because of bad apples that abuse it, some of us who are seriously hurting end up suffering. I like to hear what others used to gauge whether I am asking for something unusual.

Two weeks after my accident I returned to work full-time because I am in an office setting and able to ice/elevate my leg as I please. The down side is that by 2-3 pm I have been up on my feet so much that I get very uncomfortable. Regarding PT, I started the first day after my pins were removed and it has been 9 weeks of 2-3x/week. The therapists are excellent and were trained at University of Pennsylvania - they push me quite hard (I am icing as a write this after this mornings beating!) - my problem now is inversion/eversion, not up and down. This is exactly what I was told would be the problem.

Hey, thanks for listening this morning!


tchair 06-27-2004 06:40 AM

Re: Fractured Calcaneus
I had wanted to clarify the "walk correctly" part since there are people who can take things to an extreme. I'll try to cover the 'complication' without writing a whole book. The damaged nerve felt like it was still being cut 24/7 for years. For that alone I had a lot of tests nerve blocks, and tried a lot of medications. Some of those were narcotics, others where anti-epileptics which often help in nerve damage. When I finally got to the point where "all other treatments had failed" I got an implanted nerve stimulator. It's a little pulse generator that sends a tiny current through wires to the nerve and prevents the pain signal from reaching the brain. After many thousand pills, I stopped taking any the day I got the stimulator.
Part of what makes PT hard is the length of time that it is delayed. It sounds like you got a much earlier start than I so things didn't stiffen up so badly. The nerve damage may have made it tougher for me. I mainly wanted to make the point that if you needed meds to get through PT you should use them.

From personal experience and reading about others' It seems that some (not all) docs have an arbitrary maximum time that they will prescribe pain killers and simply stop at that point regardless of the patients' needs. When I wanted to get back to working full time I recall my surgeon saying, "You shouldn't still be in so much pain." I replied "So do something about it!" There are docs that seem to blame the patient when all doesn't go as planned. You are right, there are those who are in real pain who are told to "Live with it." There are also those who suffer simply because they are afraid to ask. Even with a good doc they are using trial and error. They have to find out from you if they are giving the correct med and dose.

I compare a bad injury to going to a foreign country. You are out of place, inexperienced and afraid to make mistakes.
The answer to "I am asking for something unusual" and similar questions you can reason out yourself. What is important is not the type or quantity of meds but your quality of life. Is the pain keeping you from sleeping? Is it causing a lot of physical and/or emotional stress? Is it preventing you from activities in your work and home life that you should be capable of at this point in time? The next place to seek advice is your wife. She's an expert about you, cares about you and can be more observant and objective.

For inversion, I believe that in this injury the joint and tendons that keep your foot laterally stable take the worst hit. Although it wasn't as easy and comfortable as prior to my injury, I have been able to do work on my roof and even plan to re-shingle it myself. Going back to eight months post injury, I still had inversion/eversion problems that didn't improve because the pain prevented me from using the proper muscles. I started wearing an 'air cast' - two plastic pieces that strap around the ankle for support. I was gradually able to loosen the straps and within two months didn't need it any more.

As for listening, I check the boards periodically because when I had these questions there was nobody anywhere that knew anything and I don't ever want anybody to go through that!

Here's my answer about kids. Be patient with yourself. A lot of your problems are temporary. Indoor activities will be just as rewarding as outdoors as long as you join in. The most important thing for them has nothing to do with your physical abilities, it's your attention and what's in your heart. Kid's are adaptable. Be open with them and they will understand completely. In fact hiding problems will confuse them leading to worry about you and themselves needlessly.

jfarrell 06-29-2004 07:51 AM

Re: Fractured Calcaneus

Thanks for the message. As you know, it is a big help to bounce things off someone who has been there. I am scheduled to see my doc again first week of August for a final xray to verify proper bone healing. I anticipate we will find that the bone has healed in an acceptable fashion. So, that leaves me with the question of what to do next. I will continue the PT. My insurance covers 80% of 60 visits - so far I have been about 25x. I think I should have an MRI done to see the status of the tendons. The PT tells me to push through the pain, which I am trying to do, but day to day is still filled with such an unstable foot, I feel like I need someone to make sure things are in the right place before I heal incorrectly.

Today I placed a call to refill the pain med's and I am curious to hear the doctor's reply. I'll let you know what happens.

By the way, did our doctor refer you to the pain specialist or did you seek that person out on your own?


tchair 06-30-2004 03:36 AM

Re: Fractured Calcaneus
For the subjects of pain and instability you want to be prepared for your appointment. The doc must rely on what you report. While he may make some observations about instability, there are no tests for pain. So be ready to explain both in a concise manner. Having prepared notes is a good idea since you can often feel rushed by their limited time and get side tracked before getting your information across. Note down how the pain feels, with activity, PT, at rest, etc. Your doc may see some pain as normal at this time and especially from PT so the more specific you are the better he can judge. The 60 visits would be based on the average for the injury. If your physician found more to be necessary the insurance should cover it, although it might take a little longer for a more thorough review by them. The PT's job is to motivate you. Most are proficient at that and how far they should push you. They should know enough not to have you get injured, faint, or be afraid to come back. I think that they can judge how much distress you may be in, but they don't know exactly how much pain you are experiencing. So your input is important. There were a few times durring PT that I said I had to stop for a bit before I went on and a few more when I just had enough. For the latter the PT had me do less demanding tasks so that neither of us would feel that I had 'quit' afterwards. I used to ask him (through clenched teeth with my best Clint Eastwood impression); "You got a mean streak, don't you?"

I'm no doc but I think the stuctural healing would be done. I think it is the swelling, muscle tone, circulation etc. that your waiting on. I've seen a few people go through this now and they (we) were all worried at this early stage. I recall one that thought she'd never ride her horse again, but less than a year later she was back in the saddle and loving it.

My surgeon was a tough case. Like many he did his job - fixing the bones and that was it. I questioned him about the pain, asked and begged, then after reading some online forums realised that the problem was over his head or not of concern to him and most importantly he wasn't going to admit either, just ignore it. I learned from others that in that case you either take control of the situation or just suffer. So I said exactly this to him: "My pain is intolerable, so please either do something about it or get someone who will." That's when he got me an appointment at a pain management clinic. If that hadn't happened I would have started looking on my own.

This is getting long but if it helps.. The doc might be doing a wait and see if things improve on their own. He won't be able to give you an exact time table or certain outcome. But do expect your concerns to be addressed, some response to all questions and explainations of anything that you don't understand. Always give the doc the information he needs and the opportunity to follow through. Your doc might be doing the best for you and the only problem the injury. He may say your problems are expected at this stage. But I've yet to hear of any good doctor that had any qualms about getting other professional opinions.

Do keep us informed, "us" including the next one who comes along and can learn from your experience.

jfarrell 06-30-2004 08:47 AM

Re: Fractured Calcaneus

Thanks again for all of the input. I will be prepared to discuss everything in detail July 29 when I see him next. He has given me the name of a surgeon who would handle any further work. He was very honest the last time I spoke him telling me that his part was done- even told me that one doc in his 'group' does do 'the next step', but referred me outside, to a doctor whose reputation is well known in the area.

How did you discover that there was nerve damage? How would you describe the pain related to that?

Thanks again.

tchair 07-01-2004 04:35 AM

Re: Fractured Calcaneus
Diagnosing the nerve damage took years. The PMC (pain management center) has docs from many disciplines and it wasn't until the others gave up and handed me over to the one specializing in neurology that we started to narrow it down. Nerves don't show up in x-rays, CAT scans etc. EMGs may or may not show a problem exists but even if so doesn't reveal what is wrong. That narcotics were some help meant little. When at least one AED (anti epileptic drug) helped was a hint. The fact that a series of anesthetic blocks (infusions, spinal, and extremities) didn't work didn't answer anything. Then a block directly into the suspected nerve was the eureka moment. Even then nerve damage is still the working diagnosis unless they dig in there to make absolutely sure. That as I'm told might give an exact answer, but the digging could also make matters far worse.

Docs like answers in their language i.e.: the pain is sharp, dull, throbbing, aching and constant or intermittent, etc. What I told them was that there was a pair of scissors stuck through my foot and still there. With a whole lot of meds, near 6,000 pills a year, it still felt like I had stepped in a bear trap and the teeth were left in. I don't know that sharp pain is specific to nerve damage or not, and even if 'I' said so it's the docs that have the proper training and experience. You're going to have to have patience through your recovery and with the docs as their profession includes some trial and error.

Edited to add: there were some other posts on this board that might be on interest. If you click on "Search" in the upper right and enter: calcaneus fracture you will get a listing. You could try the same on the web.

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