Foot & Ankle
Calcaneal Fracture
Non-Operative & Operative management
About Your Injury
The calcaneus (heel bone) is the largest bone in the foot and is commonly fractured after a fall from height landing on the heel. Many calcaneal fractures are treated surgically, but fractures that do not significantly disrupt the joint surfaces or the overall shape of the heel can often be managed without surgery.
Non-Operative Management
Selected calcaneal fractures can be safely and effectively managed without surgery. The decision is individualised to each patient, based on patient factors (age, comorbidities, occupation) and specific characteristics of the fracture (displacement, joint involvement, heel height and width).
Recovery Timeline
Weeks 0–2
Splint, strict non-weight-bearing, and elevation to manage swelling.
Weeks 2–6
Boot or cast, remaining non-weight-bearing; swelling and skin condition monitored closely.
Weeks 6–10
Gradual, protected introduction of weight-bearing.
3–6 months
Progressive return of walking tolerance and activity.
Follow-Up Schedule
2 weeks
Clinical review, with a focus on swelling and skin condition.
6 weeks
X-ray to assess healing before weight-bearing begins.
3 months
Review of weight-bearing progress and walking pattern.
Subtalar Osteoarthritis
Calcaneal fractures involve the joint surfaces of the heel bone, and even with good non-operative healing, the subtalar joint (the joint just below the ankle) can go on to develop osteoarthritis over time. This may not cause problems for many years, if at all, but for some patients it leads to ongoing pain and stiffness in the heel and hindfoot. If subtalar osteoarthritis becomes significant and is not adequately controlled with footwear modification, orthotics, and activity changes, a subtalar fusion may be considered in the future — a separate procedure to your current fracture treatment.
Operative Management
Fractures that significantly disrupt the joint surfaces or the overall shape of the heel are treated with surgery to restore heel height, width, and joint alignment. This is a significant injury — recovery is prolonged, typically taking 6–12 months, and some patients, unfortunately, do not return completely to their pre-injury baseline.
Surgery is performed through a sinus tarsi approach — a smaller incision on the outer side of the heel — using a calcaneal wave plate contoured to restore the normal shape of the heel and realign the joint surfaces. In select fracture patterns ('tongue-type' fractures), the fracture may instead be amenable to fixation with percutaneous screws alone, avoiding a larger incision. This procedure is performed under general anaesthetic, with local anaesthetic infiltration at the time of surgery for good pain control in the first 12–24 hours afterward, and usually requires a hospital stay of one to two nights.
Recovery Timeline
Weeks 0–2
Cast, strict non-weight-bearing, and elevation to manage swelling.
Weeks 2–6
Boot, remaining non-weight-bearing.
Weeks 6–10
Weight-bearing as tolerated in the boot, with physiotherapy commencing once walking well.
10 weeks
Weaning from the boot begins.
3 months
X-ray to confirm union.
3–12 months
Recovery continues to progress well beyond union — this is a significant injury, and swelling, stiffness, and altered walking pattern can take up to a year to settle. Some patients, unfortunately, do not return completely to their pre-injury baseline, particularly for higher-impact activity.
Follow-Up Schedule
2 weeks
Wound check; transition from cast to boot.
6 weeks
Clinical review; progress to weight-bearing as tolerated in the boot.
3 months
X-ray to confirm union.
Subtalar Osteoarthritis
Calcaneal fractures involve the joint surfaces of the heel bone, and even with good surgical fixation, the subtalar joint can go on to develop osteoarthritis over time. This may not cause problems for many years, if at all, but for some patients it leads to ongoing pain and stiffness in the heel and hindfoot. If it becomes significant and is not adequately controlled with footwear modification, orthotics, and activity changes, a subtalar fusion may be considered in the future — a separate procedure to your current fracture treatment.