Fracture of the calcaneus (heel bone) with malunion means the fracture heals but the bone is not knitted back together properly. With calcaneus malunion, the fracture can separate, the bone widens, and deformity results.
The injury can affect the bone above (the talus) and the supportive soft tissue structures. Recovery is very slow and many times the bone just doesn’t heal. Sometimes, the impact of the talus above the calcaneus down into the calcaneus causes a loss of hindfoot height. Change in the angle between the talus and the calcaneus occurs. As a result of all these changes, the affected person can no longer walk normally.
There may be some treatment that could be effective for you. Your surgeon is really the best one to advise you on this. A thorough physical history and exam (PH&E) is needed to identify all areas that are affected. Information on the location of any pain present, what increases or decreases the pain, and any previous treatment is reviewed.
Motion, strength, and sensation are assessed. X-rays taken in the standing (weight-bearing) position from different angles (side, back, above) show the fractures lines, of course. But the images also give the surgeon an idea of the new shape of the bones, changes in alignment and angles, and deformity or changes in weight-bearing load. CT scans can also be very useful as they provide a three-dimensional (3-D) view of the bones and joints. From the CT scans, surgeons gain a better appreciation of any deformities and joint damage.
These pieces of the puzzle are important when planning treatment because there usually isn’t one simple problem that must be addressed. There are often multiple factors to consider. Besides changes in anatomy, biomechanics, and gait (walking pattern), your lifestyle, goals, expectations, and needs at work, home, and play must all be reviewed. Other health or medical problems may enter the mix as well.
Management may begin with conservative (nonoperative) care. The goals are to decrease pain and improve comfort and function. Nonsurgical treatment can include the special shoes you don’t really want. But it is possible that orthotics (shoe inserts) or some other type of bracing that can be hidden by clothes might be helpful.
Physical therapy is an important part of conservative care. The therapist focuses on improving joint motion, strength, and movement patterns needed for walking, daily activities, work, and recreational activities or hobbies.
For those patients who have severe deformities that cannot be treated conservatively (or for those who do not respond to nonoperative care), there are a variety of surgical techniques that can help. The surgeon chooses the best surgical approach based on the problems present at the time of the evaluation.
The surgeon does everything possible to correct deformities, improve alignment, and decompress (take pressure off) tendons or nerves. Bone may be removed from some areas or built up in other areas to correct alignment or restore calcaneal height. Hardware such as pins or screws may be needed to hold the bones together until fusion is complete. Intra-operative X-rays (taken during surgery) are used to make sure everything is lined up correctly.
Not knowing what’s been tried so far, we can’t say what approach will be best for you. It may be time to make a follow-up appointment with your orthopedic surgeon — get reassessed and find out what options are available to you. Good luck!