Post-Surgery Pain and Recovery After Calcaneal Fracture

Postoperative care for calcaneal fracture?

1: Hello, doctor.
On January 7, 2023, I fell from a shelf and sustained a comminuted fracture of the posterior lateral heel in both feet.
I underwent an open reduction and internal fixation surgery on January 7, where plates and screws were inserted.
As of April 29, the doctor has informed me that the bones have healed and I can begin 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 unstable and wobbly.
The doctor explained that the pain is due to a lack of soft tissue on the heel.
Is that true? Why has the soft tissue and fat around my heel diminished? Is it because the bone is making contact with the ground, causing the pain? What can I do to promote soft tissue growth in my heel so that I can walk without pain and maintain stability?
2: Regarding the surgical site, the outer area of the incision feels numb and has a tingling sensation.
3: What potential long-term effects should I expect? Is there a possibility of having one leg shorter than the other?
4: Even though the bones have healed, why can I only descend stairs one step at a time instead of going 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 tools specifically designed to promote soft tissue growth in the 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.
I feel like the rehabilitation is not helping much.
The main issue is that after just a few minutes of walking, my heel starts to hurt significantly, preventing me from continuing.
These are my questions.
Thank you for taking the time to respond.

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 around the calcaneus, and even if the bone heals, the injuries in these areas may not fully recover.
Surgical intervention is significantly better than non-surgical treatment, but there will still be a certain gap compared to the condition before the injury.
If you have diligently rehabilitated for three months and still see no improvement, it is advisable to consult a specialist in foot and ankle surgery.
You may consider seeing Dr.
Chen Yen-Yu or Dr.
Zhu Chia-Hung at Hsu Chuan Hospital for a thorough evaluation.

Reply Date: 2023/05/01

More Info

Post-surgery pain and recovery after a calcaneal fracture can be a complex process, and it is understandable to have many questions regarding your condition. Based on your description, it appears that you have undergone surgery for a comminuted fracture of the calcaneus (heel bone) and are now experiencing significant discomfort and functional limitations despite the bone having healed. Let’s address your concerns one by one.

1. Pain in the Heel After Bone Healing: It is not uncommon to experience pain in the heel even after the bone has healed. This pain can be attributed to several factors. First, the soft tissue surrounding the heel, including muscles, tendons, and fat pads, may have been affected during the injury and surgery. If there is a loss of soft tissue (muscle or fat) in the area, it can lead to increased pressure on the bone when standing or walking, resulting in pain. Additionally, the nerves in the area may still be sensitive or irritated, contributing to discomfort. To alleviate this, physical therapy focused on strengthening the muscles around the heel and improving balance may be beneficial. Gradually increasing weight-bearing activities can also help the body adapt to the pressure on the heel.

2. Scar Sensitivity: It is common for surgical scars to be sensitive or to have altered sensations, such as tingling or numbness. This can be due to nerve endings being affected during the surgery. Over time, as the scar matures, these sensations may improve. Gentle massage around the scar and the use of silicone gel sheets can help in reducing scar sensitivity and improving the appearance of the scar.

3. Potential Long-term Effects: After a calcaneal fracture, there can be long-term consequences, including the possibility of developing arthritis in the joint, chronic pain, or issues with foot mechanics. Regarding the concern about leg length discrepancies, it is generally unlikely unless there was significant displacement of the fracture or if the healing process led to malunion (healing in an incorrect position). Regular follow-ups with your orthopedic surgeon can help monitor for these issues.

4. Mobility Challenges: The difficulty you are experiencing with descending stairs and maintaining balance is not unusual after such an injury. The heel plays a crucial role in balance and weight distribution. If the heel is painful or unstable, it can affect your ability to navigate stairs safely. It is essential to continue working with a physical therapist who can provide exercises to improve strength, balance, and proprioception (awareness of body position).

5. Rehabilitation and Recovery: Rehabilitation after a calcaneal fracture typically includes a combination of physical therapy modalities, such as electrical stimulation, heat therapy, and manual therapy, to promote healing and reduce pain. While these treatments may seem limited, they are designed to facilitate recovery by improving circulation, reducing inflammation, and enhancing muscle function. It is important to communicate with your physical therapist about your concerns and the specific goals you wish to achieve, including pain management and functional mobility.

In conclusion, while it is frustrating to experience pain and limitations months after surgery, it is essential to remain patient and committed to your rehabilitation program. Healing takes time, and addressing both the physical and psychological aspects of recovery is crucial. If your pain persists or worsens, or if you have concerns about your recovery, do not hesitate to reach out to your healthcare provider for further evaluation and support.

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