Trauma · Foot & ankle

Calcaneus ORIF

Open reduction and internal fixation of the heel bone to restore its height, width, and joint surfaces.

Overview

Labeled anatomy of the foot showing tarsal bones (calcaneus, talus, cuneiforms, cuboid, navicular), metatarsals, and phalanges.
Foot and ankle anatomy. The foot contains 26 bones: seven tarsals in the back half (including the talus and the heel bone), five metatarsals forming the arch, and fourteen phalanges in the toes. The ankle joint sits between the talus and the two leg bones — tibia and fibula.
Blausen Medical · Wikimedia Commons · CC BY 3.0

The calcaneus is the largest bone in the foot and carries the full load of body weight with every step. Most calcaneus fractures follow axial-loading injuries — typically falls from height — and often drive into the subtalar joint.

Operative fixation is considered for displaced intra-articular fractures, significant loss of heel height, or a widened heel that will not fit in a shoe. The goal is to restore the subtalar joint surface and the overall shape of the heel, since both are critical for normal hindfoot mechanics.

Why it's done

Calcaneus ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

  1. Displaced intra-articular fracture

    Step-off in the subtalar joint surface drives early arthritis.

  2. Loss of calcaneal height

    A shortened heel changes ankle mechanics and shoe fit.

  3. Widened or laterally displaced tuberosity

    A wide heel impinges against the peroneal tendons and the fibula.

  4. Tongue-type fractures threatening the skin

    Displaced tongue fragments can tent the skin and need urgent reduction.

How it works

Lateral heel X-ray showing a calcaneus fracture fixed with an intraosseous C-nail and multiple transverse screws.
Post-op calcaneus ORIF. Modern fixation uses a small intraosseous nail with locking screws to restore the heel-bone shape and height through a smaller incision than the older extensile lateral approach.
Wikimedia Commons · CC BY-SA 4.0

Traditional fixation uses an extensile lateral approach with a pre-contoured calcaneus plate and multiple screws once the soft tissue has rested and the swelling has come down. This gives the best visualization of the posterior facet.

Minimally invasive sinus-tarsi approaches with percutaneous screw fixation are used in selected patterns to reduce wound complications. Fluoroscopy and direct inspection confirm that the subtalar joint surface is smooth and the overall calcaneal shape is restored.

Recovery

Patients are splinted initially, then placed in a boot. Strict non-weight-bearing is standard for ten to twelve weeks because the calcaneus loads with every step. Range-of-motion exercises for the ankle and subtalar joint begin once the wound is healed. Graduated weight-bearing starts around three months. Despite a good reduction, post-traumatic subtalar arthritis remains a known long-term risk, and subtalar fusion may be considered later if symptoms develop. Hardware is removed only if it becomes symptomatic.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Further Reading

External patient-education references and related OSI pages for additional background: