dorsum of the foot is shortened and the heel abnormally prominent. The head of the astragalus projects into the bend of the ankle and may be readily recognized in this position. The condition may be compound as shown in Figs. 773 and 774. Anterior luxations are extremely rare. The heel is shortened and the dorsum of the foot lengthened. Palpation reveals the astragalus in its tibio-fibular mortise.
Diagnosis. — The diagnosis of these luxations is based on the characteristic deformities just described. If the swelling is intense it may be difficult to recognize the exact nature of the de- formity. An X-ray is of the greatest value in ascertaining the details of the injury. Treatment. — There is seldom much difficulty in reducing the deformity. In the lateral luxations the surgeon secures a firm grasp of the heel with one hand and the dorsum of the foot with the other, and by strong traction the foot is brought back into position. Counter-traction will usually be needed and should be made by an assistant, above the ankle. In backward luxations forward traction should be exerted on the heel while the leg is fixed. The reverse manipulation is performed to correct anterior lux- ations.
The parts should be fixed in a plaster cast extending from the middle of the leg to the toes and cut open before the plaster has dried. Operative Treatment. — If reduction cannot be performed by manipulation, open incision with direct reposition of the displaced bones should be performed. 702 FRACTURES AND DISLOCATIONS After-Treatment. — Firm union of the lacerated ligaments will be present at the end of two and a half to three weeks. Passive motion should be begun at the end of ten days but the patient should not be allowed to bear his weight on the foot inside of three weeks from the time of the accident.
Prognosis. — The loss of function following this accident is very trivial if proper reduction of the displacement has been accom- plished following the injury. Like dislocations in other joints, the too early use of the parts is likely to be followed by recurrence of the luxation which mav even become habitual.
<Callout type="important" title="Proper Reduction">Reduction should be performed with strong traction and counter-traction from an assistant.</Callout>
Fracture of the calcaneum may result from falls on the foot, from muscular contraction and from forcible twisting of the foot. The fracture may be transverse, or longitudinal, and not infre- quently extensive comminution of the bone exists. Any portion of the bone may be broken and the posterior part is often displaced Fig. 775. Fig. 775. — Fracture of calcaneum.
<Callout type="risk" title="Comminution Risk">Comminution can increase the width of the bone, making reduction more challenging.</Callout>
Symptoms. — The patient complains of pain in the region of the injury particularly Avhen an attempt is made to stand on the foot. If weight is placed on the heel the direct pressure produces suf- fering. If the weight is placed on the ball of the foot the action of the calf muscles will pull upward on the calcaneum and the at- tempt will be equally painful. Swelling usually develops promptly following the accident and is noted on either side of the foot below the ankle, especially to the inner side.
<Callout type="warning" title="Avoid Early Weight-Bearing">Early weight-bearing can lead to recurrence or worsening of the injury.</Callout>
Treatment. — The treatment of fracture of the os calcis is to immobilize the foot in a position which will correct the deformity. Complete plantar flexion of the foot relieves, to a large extent, the displacing pull of the calf muscles inserted through the tendo Achillis.
<Callout type="tip" title="Plaster Stirrup">A short, well padded, plaster stirrup is usually best for immobilization.</Callout>
Operative Treatment. — Aside from tenotomy (which is rarely needed) operation is called for in compound cases, and in instances FRACTURES AND DISLOCATIONS OF CALCANEUM 707 in which the fragment has been detached and displaced upward by the pull of the calf muscles.
After-Treatment. — Union takes place rapidly in the calcaneum but it should be remembered that the strain imposed on the bone in walking is great, and unless the callus is solidly ossified sec- ondary deformity may develop.
Key Takeaways
- Proper reduction of calcaneum fractures requires strong traction and counter-traction from an assistant.
- Early weight-bearing can lead to recurrence or worsening of the injury.
- Immobilization with a plaster stirrup is often necessary for treatment.
Practical Tips
- Always seek professional medical assistance for suspected calcaneum injuries, as improper handling can exacerbate the condition.
- Use a well-padded and properly applied plaster stirrup to immobilize the foot during recovery.
- Avoid putting weight on the injured foot until at least three weeks after the accident.
Warnings & Risks
- Comminution of the calcaneum can make reduction more challenging and increase the risk of complications.
- Early use of the foot in walking can lead to recurrence or worsening of the injury, causing long-term functional issues.
Modern Application
While the techniques described in this chapter are rooted in historical practices, the principles of proper immobilization, reduction, and gradual weight-bearing remain crucial for modern survival preparedness. Understanding these methods ensures that one can provide initial care until professional medical assistance is available.
Frequently Asked Questions
Q: What should I do if I suspect a calcaneum fracture or dislocation?
Seek immediate medical attention as improper handling can worsen the injury. Apply a splint to immobilize the foot and avoid putting weight on it until professional help is available.
Q: How long should I wait before resuming normal activity after a calcaneum fracture?
Avoid bearing weight on the injured foot for at least three weeks. Gradual reintroduction of weight-bearing activities under medical supervision is recommended to prevent complications.
Q: What are the signs that indicate a need for surgical intervention in a calcaneum injury?
If reduction cannot be achieved through non-surgical methods, or if there is significant displacement and comminution of the bone, surgery may be necessary to reposition and stabilize the fracture.