Case Study: Open Reduction and Internal Fixation of the Calcaneus – Taking the First Steps

Absolute Balance received a referral for a 29-year-old roof tiler who sustained a broken calcaneus (Heel Bone) after falling off a roof at work onto his outstretched leg. After a trip to the emergency room, it was clear that immediate surgical intervention had to be done, with the treating surgeon performing an Open Reduction and Internal Fixation (ORIF) of the right calcaneus. The surgeon had described this break as “the worst I have ever seen” and believed that this worker would unlikely return to his pre-injury job role as a roof tiler. Below is the success story of how this client was able to return as a roof tiler over the last 9 months.

An ORIF of the calcaneus can be considered the gold standard treatment recommendation following a traumatic injury of the ankle. Anatomically the calcaneus contains multiple attachment sites for surrounding ligaments and tendons so any injury to this region can have significant complications in years ahead. These complications include ankle joint osteoarthritis and permanent impairment resulting in potential further surgical intervention.

When the client first began his exercise rehabilitation with Absolute Balance, he had commenced light duties at work and weekly visits to the physiotherapist. The client was motivated to return to his pre-injury job role as a roof tiler and return to his hobbies which include fishing and playing with his kids, however, was uncertain due to how his ankle presented.

Goal: Return to pre-injury duties as a roof tiler

Injury: ORIF of right calcaneus

History: ORIF surgery of right ankle on at the end of October 2019. No previous injury history.

Assessment: Significant restriction in ankle dorsiflexion, plantarflexion, eversion and inversion with noticeable swelling and gait pattern abnormalities. Reported mild discomfort along the outside of the ankle and had visible muscle wastage in right lower limb.

Key Physical Demands: Repetitive ladder climbing and frequent lifting of loads up to 25kgs from the floor when carrying tiles.

Programme Goals: Improving range of motion, stability and proprioception through the right ankle and progressing to full weight-bearing activities necessary for his pre-injury job role.

An individualised gym-based programme was created following the assessment of the client’s physical capacity and physical job demands with weekly supervised sessions conducted at a gym close to home. The client began independently attending the gym on top of our supervised exercise consultations to assist in promoting self-management.

Due to the significant reduction in range of movement in the right ankle, our initial focus was on range of motion, balance and proprioception to assist in reducing swelling and promote a normal walking gait pattern to facilitate a heel-toe strike and increase stride length. The programme progressed to increase lower limb strength and function, focusing on correct manual handling techniques to assist with a timely return to work.

This client can now perform step-ups repetitively with 25kg load and can also perform floor to shoulder height lifts to 25kgs.

Through empowerment and education, the client has taken control of his injury and is on his way to returning to work as a roof tiler. This case study will be revisited soon with an update on what stage of the rehab timeline he is at.

If you would like more information on managing ankle specific injuries please contact Absolute Balance by mail info@absolutebalance.com.au or visit our website www.absolutebalance.com.au

Joel Skinner (B.Sc Exercise Science and Rehabilitation)

Accredited Exercise Physiologist (AEP) (AES) (ESSAM)