Post-Surgery Pain and Recovery After Calcaneal Fracture

Post-operative care for calcaneal fracture?

1: Hello, doctor.
I fell from a shelf on January 7, 2023, resulting in a comminuted fracture of both heels.
I underwent an open reduction and internal fixation surgery on January 7, where plates and screws were inserted.
It is now April 29.
The doctor said the bones have healed and I can start rehabilitation.
Here are my questions: Why does my heel hurt so much when I stand or walk, even though the bones have healed? I feel unsteady and wobbly.
The doctor explained that it is because there is no muscle on my heel, which causes the pain.
Is this true? Why is there no muscle or fat on my heel? Is it because the bones are making contact with the ground, leading to heel pain? What can I do to promote muscle growth on my heel so that it doesn’t hurt when I walk and I can maintain my balance?
2: The scar on the outer side of the wound is numb and has a tingling sensation.
3: What kind of long-term effects can I expect? Will there be a discrepancy in leg length?
4: Even though the bones have healed, why can I only descend stairs one step at a time? I cannot go down quickly like normal.
5: It has been four months; why am I still not fully recovered? Will I get better?
6: Are there any rehabilitation devices that can help promote muscle growth on my heel? During my rehabilitation sessions, I only receive electrical stimulation and heat therapy (what are the benefits of these treatments?), along with stretching exercises from the therapist to increase muscle endurance.
It feels like the rehabilitation is not very helpful.
Mainly, when I walk for just a few minutes, my heel hurts intensely, and I cannot continue walking.
These are my questions.
Thank you for taking the time to answer them.

Dàshén, 40~49 year old female. Ask Date: 2023/05/01

Dr. Chen Bochen reply Orthopedics

Hello, the calcaneal fracture itself is a very difficult injury to heal.
There are many tendons, ligaments, and small nerves surrounding the calcaneus, and even if the bone heals, these areas may not fully recover.
Surgical intervention is significantly better than non-surgical treatment, but there will still be a certain degree of difference compared to the condition before the injury.
If you have diligently rehabilitated for three months and still see no improvement, I recommend consulting a specialist in foot and ankle surgery.
You can seek a thorough evaluation from Dr.
Chen Yen-Yu or Dr.
Chu Chia-Hung at Hsu Chuan Hospital.

Reply Date: 2023/05/01

More Info

After a calcaneal fracture and subsequent surgery, it is common to experience pain and discomfort during the recovery process. Your situation, where you have undergone internal fixation with plates and screws, is not unusual. Let’s address your concerns one by one.

1. Pain in the Heel After Bone Healing: It is indeed possible to experience pain in the heel even after the bone has healed. This can be attributed to several factors. One reason could be the lack of soft tissue (muscle and fat) cushioning around the heel. When the bone heals, the surrounding soft tissues may take longer to recover, leading to discomfort when weight is placed on the heel. The pain you feel when standing or walking could be due to the increased pressure on the bony prominence of the heel, especially if there is insufficient padding. To help alleviate this, you might consider using cushioned footwear or heel pads to provide extra support and reduce pain during weight-bearing activities.

2. Scar Sensitivity: It is common for surgical scars to be sensitive or to have a tingling or numb sensation. This is due to nerve endings being affected during the surgery. Over time, this sensitivity usually decreases as the nerves heal and the scar matures. Gentle massage around the scar area can sometimes help improve sensation and reduce discomfort.

3. Potential Long-term Effects: After a calcaneal fracture, some patients may experience complications such as chronic pain, stiffness, or even a discrepancy in leg length (shortening of the affected limb). However, these outcomes vary widely among individuals. Regular follow-ups with your physician and physical therapist can help monitor your recovery and address any concerns early on.

4. Mobility Issues: Difficulty descending stairs or maintaining balance can be related to several factors, including muscle weakness, joint stiffness, or proprioceptive deficits (the body’s ability to sense its position in space). It is essential to gradually work on strengthening exercises and balance training as part of your rehabilitation program. If you find that you are still struggling with mobility after four months, it may be beneficial to discuss this with your healthcare provider to ensure that your rehabilitation plan is tailored to your needs.

5. Rehabilitation Goals: The goal of rehabilitation is to restore function and strength to the affected area. While modalities like electrical stimulation and heat therapy can help reduce pain and promote healing, they are often complemented by active exercises aimed at improving strength, flexibility, and balance. If you feel that your current rehabilitation program is not addressing your concerns, it may be worthwhile to discuss this with your physical therapist. They can modify your program to include exercises that specifically target muscle strengthening around the heel and improve your overall stability.

In summary, while it is normal to experience pain and mobility issues after a calcaneal fracture, it is crucial to continue working closely with your healthcare team. They can provide guidance on pain management strategies, rehabilitation exercises, and monitor your recovery progress. With time, patience, and appropriate rehabilitation, many patients see significant improvements in their function and reduction in pain. If your symptoms persist or worsen, do not hesitate to reach out to your physician for further evaluation.

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