CASE VIGNETTE – AUGUST 2019

Lovers’ Heels
How many of you have heard of this injury – Lover’s Heels?

In simplest terms, it refers to fractures of one or both of the calcanei or heel bones. It is classically sustained by a male who has been unexpectedly found in a bedroom with another man’s wife. As the husband of the household ascends the steps to the bedroom, the lover jumps from the bed, runs to the verandah and leaps over the railing. Landing on the concrete driveway three metres below gives rise to this awful injury.

Heel fractures are particularly troublesome in orthopaedic surgery. They give rise to extreme pain and extraordinary swelling. Bed rest, elevation, ice and analgesia are the hallmarks of early treatment, especially if the fracture is extensive and comminuted (many fragments).

The calcaneus or heel bone forms a very important joint with the ankle bone or talus. This so-called “subtalar joint” allows the heel to move inwards and outwards when walking over uneven terrain. If this movement is restricted as a result of post-traumatic arthritis, walking becomes particularly arduous and almost impossible on soft sand, construction sites or through the bush.

Whilst these fractures can be opened surgically, pieced back together a little like Humpty Dumpty and held in position with plates, screws, wires and other devices, the joint between the talus and the calcaneus is often left irreparable.

The salvage operation is in the form of a subtalar fusion or arthrodesis. Arthrodeses are very important in that they convert a stiffish, painful joint into a stiff, painless joint. The afflicted individual loses the 10° or so of inversion and eversion of the heel, but also loses the pain. It is a most attractive trade-off.

My advice to men in this situation is initially to avoid it altogether but if the attraction is so great, stay in bed and just face the music. It’s likely to be less painful than the calcaneal fracture!