Fractured calcaneus treatment
A fracture of the calcaneus is one of the heel bones. Although it is an uncommon form of fracture, the outcomes might be crippling. In the past, a burst calcaneus fracture was referred to as a "Lovers Fracture" because the injury would happen when a suitor jumped off a lover's balcony (axial loading) to avoid being caught.
PHYSICAL MANAGEMENT
Physical therapy management of calcaneal fractures nonoperatively and surgically has several characteristics. Periods of immobilization with limited weight bearing, joint mobilization, range-of-motion exercises, pain management, strengthening, proprioception training, gait training, plyometrics, and incremental loading to resume more difficult activities are some of the commonalities between the two.
The following outcome metrics can be used to gauge a patient's functional skills and determine their prognosis in order to guide their rehabilitation:
PRE SURGERY
Initial stability is necessary for open reduction internal fixation of intraarticular calcaneal fractures.
To decrease swelling, the injured foot should be immediately elevated before surgery.
• Compression, such as a foot pump, devices that apply intermittent pressure, or compression wraps if tolerated.
• Directions for crutch walking, wheelchair transfers, and bed transfers.
POST SURGERY
Traditional immobilization and early mobility rehabilitation techniques are used in the therapy of calcaneal fractures both preoperatively and postoperatively. As a result of their similarities, the conventional immobilization regimens for nonoperative and postoperative treatment are merged in the process below. [2] Following nonoperative or postoperative treatment, phases II and III of conventional and early motion rehabilitation procedures are equivalent as well as are discussed together below.
PHASE 1-4 WEEKS
GOALS
Manage the discomfort and edema
Avoid fracture extension or loss of surgical stability
Minimise cardiovascular and functional decline
INTERVENTION
Ankle in neutral and occasionally minor eversion when being cast
Elevation
Encouraged to begin doing the toe curl and active ankle joint (dorsiflexion and plantarflexion) on the first post-operative day.
Teach non-weight bearing ambulation using crutches or walker-crutch walking after 2-4 days.
Limit the amount of time concerned extremities spend in the dependent-gravity posture by providing instruction on wheelchair use and a suitable seating routine.
Provide a thorough exercise and cardiovascular regimen that uses the upper limbs and a lower extremity that is not included.
Enhancing the muscles around the nearby joints (hip and knee)
Phase II: Weeks 5-8
Goals:
Manage any lingering or persistent discomfort and edema
By cautiously increasing weight-bearing, you can avoid re-injury or fracture complications.
Restore mobility to the ankle and foot joints to prevent contracture.
Minimise cardiovascular and functional decline
Intervention:
Maintaining elevation, icing, and compression on the affected lower extremity as necessary.
Teach partial-weight bearing ambulation with crutches or a walker after 6–8 weeks.
Start a rigorous exercise programme including range-of-motion exercises to restore and maintain mobility at all joints, including the tibiotalar, subtalar, midtarsal, and toe joints. These exercises should also include progressive isometric or resisted activities.
Complete upper extremity and cardiovascular programme development and monitoring
Phase III: Weeks 9-12
Goals:
Progress weight-bearing status
•
Normal gait on all surfaces
•
Restore full range of motion
•
Restore full strength
•
Allow return to previous work status
Intervention:
Instruction in regular full-weight bearing ambulation with the necessary assistive equipment should be given after 9–12 weeks.
Adaptation of the subtalar joint for walking on various surfaces, particularly gradated and uneven surfaces, should be improved and monitored.
Joint mobilisation for all stiff joints, including the toe, tibiotalar, subtalar, and midtarsal joints.
soft tissue mobilization to the plantar fascia, the gastrocnemius complex, or other suitable tissues that are hypomobile
using pulleys, weightlifting, toe-walking, climbing/descending stairs, skipping or other plyometric exercises, pool workouts, and other climbing activities to gradually resist-strengthen the gastrocnemius complex.
Programs or activities to prepare workers for return to work after 13 to 52 weeks are needed.
IMPLANT REMOVAL
Only cases with protruding hardware or severe arthrofibrosis with restricted range of motion, often following plate fixation using extensile methods, are recommended for implant removal one year after plate fixation. Using subtalar arthroscopy, implant removal is paired with intraarticular arthrolysis and debridement.
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