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Calcaneal sfx for 19 months

Discussion in 'General Issues and Discussion Forum' started by DrZetter, Apr 16, 2013.

  1. DrZetter

    DrZetter Member

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    You read it right. I have been battling a sfx in my left calcaneus for 19 months! I fractured it six year too and it healed in four months.

    Onset of both fractures was due to running -- high mileage.

    I have had all blood work done. I have no deficiencies. My menstrual cycle is normal. My bone density is 130% of normal for my age. I have had four sets of radiographs over the course of this injury and they all show an oblique fracture from the superior aspect of the calcaneus to about mid body. The problem is that I cannot stay off of it 100% of the time. I'm a chiropractor. I've been in and out of a cam boot all of this time as well as on and off crutches. As you can imagine my job as a chiropractor is quite physical, but I can manage to do most of my work seated. I have maintained fitness through biking, swimming and resistance training; all seated. And as of the past six weeks I am not biking or swimming in efforts to not move the calcaneus. I have been wearing the boot 98% of time or on crutches for the past six weeks.

    Given that I'm not able to be 100% non-weight bearing you would think it would have healed by now, right? Six years ago when I fractured it I was not fully non-weight bearing either. I did have two weeks in a cast which significantly limited my ability to weight bear. I have been using an Exogen US unit 2xdaily for at least six weeks and I also used one the second month after initial onset of injury (that unit broke) I also get class IV laser treatment about once a week and at one point they were five times per week. So that is the only difference in terms of treatment.

    I finally went to a podiatrist last week. I have been self treating. And he said three weeks of absolute no weight bearing. Which is impossible as I have to work. And if in three weeks I'm still in pain he wants a MRI. I suspect I will still be where I am at today at the follow-up visit. He did mention drilling holes into the calcaneus to stimulate healing. I'm not so sure about that route.

    Does anyone have experience with a non healing calcaneal stress fracture? My podiatrist was dumb founded when I told him how long it had been. I'm at a loss.


    Dr. Megan Zetter
  2. Craig Payne

    Craig Payne Moderator


    I don't think you will find anyone with any significant experience in calcaneal stress fractures.
    We did have this thread:
    Calcaneal stress fractures in minimalist/barefoot runners

    19 months - extremely unusual.

    Basic principles: cumulative load on bone is greater than what bone can take --> reduce cumulative load (ie activity reduction) and improve ability of bone to take load (bone health; progressive adaptation) ... you seem to be doing all that, so this a real mystery.
  3. Megan:

    I do have experience in treating calcaneal stress fractures and traumatic fractures of the calcaneus. Calcaneal stress fractures generally heal within 6-8 weeks so your case is rather unusual.

    First of all, I would try a different type of bone stimulator that uses pulsed electromagnetic stimulation (PEMS) such as EBI. I have had fairly good luck with this unit for such fractures, especially considering your non-success with the Exogen unit which uses ultrasound. I don't know how a laser is going to heal a calcaneal stress fracture for you.

    Second, an MRI scan, preferably done with a 3.0 Tesla MRI unit with a dedicated lower extremity coil, is critical to getting an accurate diagnosis. Radiographs are not very helpful at assessing calcaneal fracture healing. A CT scan would also be helpful, but won't show bone edema which may actually be causing the majority of your bone pain and not a stress fracture.

    Third, once the MRI scan is done, then your podiatrist should be able to make a more informed decision on how to treat your injury. If a non-union is present, which by definition would be the case if you truly still have a fracture in your calcaneus after 19months, then I don't think I would try drilling the calcaneus unless you had a second opinion from another podiatrist stating that this is the preferred treatment. Drilling of the calcaneus is not a typical treatment for nonunions of the calcaneus.

    Fourth, immobilization and non-weightbearing are very good treatments for calcaneal stress fractures. However, after this much time, you should probably get the MRI scan first before making any plans for extended immobilization or non-weightbearing periods for your injured foot.

    Hope this helps.
  4. DrZetter

    DrZetter Member

    Thanks Kevin and Craig. I appreciate your input.


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