Houston Methodist. Leading Medicine

Foot FAQ

Question:

I fell off a simple step stool and busted my heel into four parts. I heard the surgeon say I was lucky it wasn't the result of a car accident. What difference would that make?

Answer:

Studies show that some motor vehicle accidents are more traumatic because of the higher impact. Not only are the bones broken, but the soft tissues around the bones are often torn as well. In your case, it might also have to do with the fact that you fell from a step stool rather than off a high ladder or rooftop. Accidents from greater heights can also create greater trauma at the point of impact. Your surgeon is probably aware of a recent study that showed the mechanism of injury (car accident versus a fall) did seem to make a difference in the final outcomes of surgery for calanceal fractures. The calcaneus is your heel bone. The patients in the study were all 18 or older and had a displaced calcaneal fracture. Displaced means the bone was fractured and the bones had separated and moved apart at the fracture line. Those who were injured in a car accident seemed to have worse results when compared with patients who had fallen. The reasons for this weren't obvious but the authors of the study made some suggestions that might help explain the differences. They said the first possibility for these differences is that motor vehicle accidents cause more soft tissue damage along with the fracture than falls from heights. This is especially true when the fall isn't from a high ladder but rather, a low stool as in your case. Their study was based on the results of three questionnaires given to their patients years after surgery was done. But the surveys didn't ask any questions about additional injuries present at the time of the surgery. The second explanation may be that car accidents are higher-energy accidents compared with falls. The calcaneal fractures from car accidents might have caused more bone fragments or there could have been fractures of other bones in the ankle besides the calcaneus. There are any number of explanations as to why the surgeon might have said this about you. When you go in for a follow-up appointment, consider asking him or her what was meant by that statement as it applies to you. There may be a different reason than those that we can offer you based on reported studies. Michael Q. Potter, MD, and James A. Nunley, MD. Long-Term Functional Outcomes After Operative Treatment for Intra-Articular Fractures of the Calcaneus. In The Journal of Bone and Joint Surgery. August 2009. Vol. 91-A. No. 8. Pp. 1854-1860.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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