Case Study: Acute Heel Pain and Swelling Following an Axial Load Injury
Case at a Glance
A 35-year-old male presented with acute left heel pain, swelling, and an inability to bear weight after jumping from a low height onto a concrete surface.
Patient's Story
The patient reported being at his rural home when he jumped approximately one foot down from a step onto a sidewalk to scare an animal away from his property. He was barefoot at the time of the incident. Upon landing on his left heel, he heard an audible 'sput' sound and experienced immediate, severe pain. He found he was unable to bear any weight on the forefoot or heel of his left foot. He described an unusual sensation of the heel feeling 'soft' immediately following the injury.
Initial Assessment
The patient self-managed overnight with rest, ice, and elevation. The following day, he presented with significant swelling encompassing the posterior and lateral aspects of his left ankle and heel. He reported a constant, aching pain, which was exacerbated by any attempt at movement or weight-bearing. On physical examination (simulated), there would be significant tenderness to palpation in a 'horseshoe' pattern around the calcaneus and deep within the heel pad. Active range of motion was severely restricted due to pain, especially ankle dorsiflexion. The patient was unable to perform a single-leg heel raise and could not bear weight on the affected limb.
The Diagnostic Journey
The patient expressed concern about the cost of medical care due to being uninsured and hoped the injury was merely a sprain or strain. However, the mechanism of injury (axial load from a jump) combined with the clinical findings—an audible sound, immediate inability to bear weight, and significant localized swelling—raised high suspicion for a fracture, specifically of the calcaneus (heel bone). It was explained to the patient that clinical examination alone is unreliable for differentiating a severe ligamentous injury from a fracture. Anteroposterior (AP), lateral, and axial X-rays of the calcaneus were strongly recommended to assess for a fracture, which, if unstable and left untreated, could lead to significant long-term complications and disability.
Final Diagnosis
Suspected Calcaneal Fracture.
Treatment Plan
Pending definitive diagnosis via radiography, the immediate treatment plan focused on preventing further injury and managing symptoms. The patient was instructed to maintain strict non-weight-bearing status on the left leg, and crutches were recommended. The RICE (Rest, Ice, Compression, Elevation) protocol was to be continued to manage pain and swelling. An urgent referral for radiographic imaging was made, with a follow-up consultation with an orthopedic specialist scheduled to review the results and determine the subsequent course of action.
Outcome and Follow-up
The outcome is contingent on the findings of the X-ray. A non-displaced or minimally displaced calcaneal fracture might be managed conservatively with a prolonged period (8-12 weeks) of non-weight-bearing in a cast or walking boot. However, a displaced or intra-articular fracture, which is common with this mechanism, would likely require surgical intervention, such as Open Reduction and Internal Fixation (ORIF), to restore the anatomical alignment of the bone and joint surface. The importance of adhering to the diagnostic and treatment plan was emphasized to the patient to optimize the chances of a successful recovery and return to full function.