Management of Undisplaced Calcaneal Fracture

Acute Management

• The American Academy of Family Physicians recommends immobilization with protected weight-bearing for undisplaced calcaneal fractures, as simple immobilization is specifically indicated when fracture fragments are small, nonarticular, or minimally displaced 1
• Immobilization should be maintained for 6-8 weeks, with protected weight-bearing allowed during this period, avoiding full unprotected loading 1

Pain Control

• The American College of Physicians recommends starting acetaminophen as first-line analgesia for pain management 2
• Avoid NSAIDs if cardiovascular or renal comorbidities exist, and use short-term narcotic medications only if necessary for severe pain 2

Rehabilitation Protocol

• Early mobilization should be initiated as tolerated to prevent complications of immobility, with range-of-motion exercises for ankle and foot starting within the first postoperative days 2, 3
• Implement early post-fracture physical training and muscle strengthening, with progressive weight-bearing as pain and healing allow 1, 2

Management of Underlying Osteoporosis

• The National Osteoporosis Foundation recommends prescribing calcium 1000-1200 mg/day plus vitamin D 800 IU/day, which reduces non-vertebral fractures by 15-20% and falls by 20% 2, 3
• Oral bisphosphonates (alendronate or risedronate) are first-choice agents for osteoporosis treatment, reducing vertebral, non-vertebral, and hip fractures 2, 3

Monitoring and Follow-Up

• Regular monitoring for medication tolerance and adherence is necessary, as long-term adherence is typically poor, with a five-step plan to improve adherence 2
• Obtain follow-up radiographs at 6-8 weeks to confirm healing, and consider advanced imaging if symptoms persist beyond 6-8 weeks 1