The Smashed Heel

The heel pad in plantar heel pain

“…It has been ascribed to entrapment neuropathy (Baxter and Thigpen 1984;Kenzora 1987), inflammation of the plantar fascia and periosteum (Furey 1975;Sewell et al 1980), calcaneal spur (DuVries 1957;Rosenfeld 1985) and stress fracture of the calcaneum (Graham 1983;Williams et al 1987). Some authors have suggested that the basic cause is within the heel pad, with a change in compressibility due to local loss of fat with thinning of the pad or to rupture of fibrous tissue septae (Miller and Lichtblau 1965;Snook and Chrisman 1972;Miller 1982 An index approaching one meant lack of elasticity of the heel pad. The average thickness and HPCI of both feet were calculated for each normal subject and for patients in whom both feet were affected.…”

Biomechanical Evaluation of a Locking and Nonlocking Reconstruction Plate in an Osteoporotic Calcaneal Fracture Model

“…Nonoperative treatment of displaced intra-articular calcaneal fractures is associated with significant disability and morbidity. 3,6,12,17,19 Greater than 2 mm of articular incongruity in the subtalar joint can lead to early arthritis. A widened short calcaneus can result in loss of dorsiflexion, nerve entrapment as well as peroneal impingement furthering the pain and morbidity of the injury.…”

Subtalar arthrodesis with correction of deformity after fractures of the os calcis

“…7 Fractures with involvement of the subtalar joint may give rise to chronic pain and permanent functional impairment. 8,9 This is produced by subtalar incongruency, 10 a decrease in height of the calcaneus, 11,12 a widened heel with calcaneofibular abutment and/or impingement of tendon, nerve or other soft tissue, 13 a valgus or varus hindfoot, flattening of the longitudinal arch and 'smashed heel-pad syndrome'. 14,15 Treatment 16 then may vary from conservative to operative which may include lateral wall osteotomy, 1 subtalar arthrodesis 17,18 with or without a bone block, 6,8 triple arthrodesis, 3 nerve resection, and amputation.…”