Measurement of heel pad thickness following calcaneal fractures

Abstract

Objective To study whether the heel pad will have changes in thickness or injury following calcaneal fractures and whether they are correlated to heel pain. Methods Subjects were chosen randomly from the patients who had suffered unilateral calcaneal fractures between May 2001 and December 2004, had an age between 20 and 55 years, and experienced no constant heel pain before fracture. In the first week of hospitalization, standard lateral and axial radiographs were taken for bilateral calcanei without weight loading. The shortest distance between the calcaneus and the skin of heel in the lateral radiograph was measured as the heel pad thickness. In the follow-up after fracture union, the standard lateral and axial X-ray photographs of the bilateral calcanei with and without weight loading were taken again. The thickness of heel pad was also measured again. The average bilateral heel pad thickness and the heel pad compressibility were calculated. At the same time, symptoms of the injured heel were recorded and the fracture reduction observed.Results In the first week of hospitalization, the heel pad thickness without weight-loading was 21.63±2.54 mm at the fractured side and 21.23±2. 24 mm at the opposite side, the difference between the two showing no statistic significance ( t =0. 50, P > 0.05). In the follow-up (after union of fractures), the above two sets of data became 23. 11±2.24 mm and 21.31±2.21 mm respectively, the difference showing statistic significance ( t =2. 44, P 0. 05). Conclusions Heel pad injury can arise in patients following calcaneal fractures, maybe due to violent force or displacement. The injury may cause changes in heel pad thickness, and increased heel pad compressibility quotient in particular, indicating loss of heel pad elasticity. This may be one of the'causes of heel pain. Protecting the heel pad tissue and reducing secondary injury to the heel pad will reduce complications after calcaneal fractures. Key words: Calcaneus; Fractures; Heel pad; Thickness measurement; Planter heel pain