How can I tell if the plate and screws on my calcaneal fracture broke? Well, great question and that is what we’re talking about today on the Doc On The Run Podcast.
This episode comes from one of the YouTube viewers on the Doc On The Run YouTube channel and he posted a question as a comment on one of the videos, and he wanted to know, how can I tell if I broke the plate and screws on my calcaneal fracture.
Well, I’m afraid that I have more questions than answers on this one and the first thing is that what we’re talking about here is when you look at the foot, this is obviously a foot model, a skeleton, this is the heel bone. When the heel bone breaks, typically what happens is this is the outside of your foot. When you land, it blows the lateral wall or outside wall of the heel apart and so we have to do a couple of things.
Number one is the bone that sits on top of it can kind of drive down into the heel bone and push it apart and flatten the heel bone out. So, we need to tilt it back into its normal position, put the wall of the bone back on. We generally put a plate and a whole bunch of screws in there to hold it all together. Now it’s a thin plate with a bunch of screws. So, when you look at it, if you saw what the plate looked like, how thin it is, you might think it would be relatively easy to break it. Well, I guess you could break it.
But number one, my number one question here is, what is it that this guy could have done that would have made him think that he applied enough force to the broken heel bone that he then could have broken the plate after the surgery? That is the first thing. So that would take a lot of stress and strain.
If you haven’t applied enough stress to it, like falling off a ladder or tripped and fell when you were getting out of the car or something, fell off your crutches or whatever, maybe fell down the stairs, I don’t know. But if you haven’t done that, why would you be concerned about this in the first place? So that I have no idea.
Second thing is if you did fall down and accidentally stepped on the foot and you’re like really in a great deal of pain and you have swelling, you have some kind of other symptoms that might lead you to believe that you could have broken the plate and the screws on here and the hardware holding all the bone together, why haven’t you seen a doctor? I mean, I really don’t understand that.
I understand why people get questions when they’ve had chronic injuries, and they watch a bunch of videos that I have put together and then they have a general question about one of the topics that they’re not clear on. But I mean, if you’re so concerned that you broke the plate and the screws, why haven’t you seen a doctor?
Obviously, if you have a metal plate and a bunch of screws that was surgically implanted in your foot to hold the heel bone together after a calcaneal fracture, presumably you have a surgeon taking care of you. So, I’m not sure why somebody would ask me, a complete and total stranger, for advice or try to understand this better because obviously the surgeon who did the surgery would understand what kind of hardware was put in there, how likely it would have been based on the stuff I previously said that you could have broken the plate and screws.
One thing that I know is that most people, when you have a fracture of the heel bone and a surgeon goes in and puts a plate and screws on it, almost all of them are going to be completely non-weight bearing in something like a cast or a fiberglass posterior splint that goes down the back of your leg and around the bottom of the foot for somewhere between, from four weeks maybe to as long as eight weeks at the outside.
The thing in the United States, and the reason I bring this up, is that if I did your surgery and I did what’s called open reduction internal fixation of a calcaneal fracture, which is the medical term for the surgery this guy probably had, well, if you had that for 90 days, three months after the surgery, all of your postoperative care is free. So, I understand sometimes when people ask questions because they say, I don’t have any insurance, I haven’t been able to see a doctor, so I’m hoping maybe somebody on YouTube will give me some free advice. I understand that.
But if you already had surgery, it is free advice. You can go into the doctor anytime you want and see them and get them to look at it, see if they see anything that makes them concerned that you might have broken the plate or damaged the surgical repair in some way. So, in theory, it should cost you nothing to go back to the surgeon if you’re worried about some kind of complication that happened after surgery.
The closest answer I could give somebody in this case is that if there was enough stress applied to the heel bone so that it could have broken the plate, well, in that case, the patient’s experienced symptoms or something that is making him concerned that he might have broken the plate, well, okay, maybe you did. That is the first thing is, did you do something that could have done this? If you said, I came home, I sat in bed, I didn’t do anything, well, I wouldn’t be concerned at all that you broke the plate.
If you have symptoms that are consistent with a broken plate, your physical exam, when a doctor looks at you, is also consistent with broken hardware, like you have pain, you have swelling, you have visible bruising, you have drainage, your fluid coming out of the incision, or perhaps you tripped and fell on it so hard that it actually popped some of the stitches apart, well, those things would be very concerning. I would be worried that you might’ve damaged it somehow and then you have some kind of medical imaging, whether it’s an X-ray or ultrasound or a CT scan of the foot that shows the hardware might be broken. Well, if you have had hardware failure evident on one of those imaging things, then that could show you.
Calcaneal stress fractures that turn into one of these things where it’s blown apart really make doctors queasy. And I was just lecturing in Las Vegas, the International Foot and Ankle Foundation meeting, and I had a case of a calcaneal stress fracture, and this woman wanted to run a marathon 12 days out from where she couldn’t even walk on it. That makes doctors very nervous, but there are specific principles I teach to people that have these injuries that apply to all runners, and it might be useful if you’re viewing this because you think you have a calcaneal fracture or a calcaneal stress fracture, you have a heel pain that has those kind of symptoms, you might find this useful.
You can learn those strategies. Those are the same ones I was teaching to the physicians at that conference in Las Vegas just a week ago, and you can get it for free. You can come to the Heel Pain Masterclass, sign up, and I’ll teach you those strategies. You can get it if you go to www.docontherun.com/heelpainmasterclass. So come sign up, and I’ll see you in the training.
#938 Is there any research on running cadence and impact forces? »» |