Nondisplaced fractures — conservative management is standard of care
Extra-articular fractures — generally managed conservatively
Early mobilization reduces stiffness and improves functional outcomes
Functional bracing allows earlier weight-bearing than cast in some protocols
Bone healing optimization
Smoking cessation — significantly reduces wound and nonunion complications
Nutritional optimization — protein, calcium, vitamin D
Diabetes management — tight glycemic control reduces surgical complications
DVT prophylaxis — LMWH for prolonged non-weight-bearing period
Patient Discharge Instructions
copy discharge instructions
You have been diagnosed with a calcaneal (heel bone) fracture
This is a serious injury that requires careful follow-up with an orthopedic surgeon
Recovery typically takes 6-12 months; some patients experience residual symptoms for longer
Activity restrictions
Do not put any weight on the injured foot — use crutches at all times
Keep the injured foot elevated above the level of your heart as much as possible
Apply ice wrapped in a cloth to the splint or boot area for 20 minutes at a time
Do not remove or modify the splint or boot without orthopedic instruction
Your follow-up appointment
Orthopedic surgeon visit within 5-7 days — do not miss this appointment
Bring this discharge paperwork to your follow-up visit
Further imaging (CT scan) may be needed to plan treatment
Pain management
Take pain medication as prescribed — do not exceed recommended doses
Acetaminophen (Tylenol) 500-1000 mg every 6 hours as needed for pain
NSAIDs (ibuprofen, naproxen) may be prescribed — take with food
Wound and splint care
Keep the splint or boot dry at all times
Do not insert objects into the splint to scratch
Report any foul odor or discharge from a wound
Return to the emergency department immediately if you experience
Increasing pain that is not controlled by prescribed medication
Numbness or tingling in your toes or foot
Toes turning white, blue, or cold
Inability to move your toes
Worsening swelling
Skin breakdown or blistering over the back of the heel
Fever above 38.5 degrees Celsius
Foul odor from the splint or wound
References
Guidelines and key sources
Silver S, Williams E, Plunkett ML — Common Foot Fractures, American Family Physician 2024
PMID 38393796
Comprehensive review of calcaneal fracture diagnosis and management
Lewis SR, Pritchard MW, et al — Surgical Versus Non-Surgical Interventions for Displaced Intra-Articular Calcaneal Fractures, Cochrane Database 2023
Cochrane systematic review — uncertain functional benefit of surgery over conservative care
Griffin D, Parsons N, Shaw E et al — Operative Versus Non-Operative Treatment for Closed, Displaced Intra-Articular Calcaneal Fractures: HeFT RCT, BMJ 2014
PMID 25059747
Landmark trial — no significant functional difference at 2 years
Dickenson EJ, Parsons N, Griffin DR — Long-term Follow-Up From HeFT RCT, Bone Joint J 2021
PMID 34058883
5-year follow-up confirms no significant functional difference
Park YH et al — Predictors of Compartment Syndrome After Calcaneal Fracture, Bone Joint J 2018
PMID 29589492
Sanders type IV — OR 21.67 for compartment syndrome
Snoap T et al — Calcaneus Fractures: A Possible Musculoskeletal Emergency, J Emergency Med 2017
PMID 27658550
Bohler's angle sensitivity 99%, specificity 99% at ≤20 degrees threshold
Badillo K et al — Multidetector CT Evaluation of Calcaneal Fractures, Radiographics 2011
PMID 21257934
CT protocol and Sanders classification review
Smith SE et al — ACR Appropriateness Criteria Acute Trauma to the Ankle, JACR 2020
ACR imaging guidelines for calcaneal fracture evaluation
Walters JL et al — Association of Calcaneal and Spinal Fractures, J Foot Ankle Surg 2014
PMID 24618246
7-22% concomitant vertebral fracture rate with calcaneal fractures from falls
Myerson M, Manoli A — Compartment Syndromes of the Foot After Calcaneal Fractures, Clin Orthop 1993
PMID 8472441
Classic description of foot compartment syndrome management
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