A systematic review and pooled analysis in the Journal of Orthopaedics and Traumatology included 20 studies with 1,051 patients who underwent surgery for unilateral displaced intraarticular calcaneal fractures (DIACFs). Study designs ranged from 3 randomized controlled trials to 14 retrospective series, with a median patient age of 44 years and 79% men. The findings suggest that decades-old rehabilitation protocols recommending prolonged non-weight bearing may be unnecessarily cautious and highlight the need for randomized trials to guide evidence-based updates.
Patients treated under early weight-bearing protocols reported a mean American Orthopaedic Foot and Ankle Society score of 86, a Maryland Foot Score of 91, and a mean visual analog pain score of 2 out of 10. Radiographic stability was preserved, with Böhler’s angle declining by only 0.4° between surgery and final follow-up at a mean of 23 months.
Complication rates were within expected ranges. Across 16 studies that reported events, the overall median was 14%, with superficial wound infections ranging from 3% to 22%, deep infections 2% to 18%, and hardware-related failure up to 17%. Rates of secondary arthrodesis and nerve entrapment were low but inconsistently reported.
Surgical approaches varied, including extensile lateral (13 studies), sinus tarsi (11), and percutaneous fixation (1). Outcomes were generally favorable across approaches.
Limitations included high heterogeneity across studies, inconsistent definitions of complications, lack of standardized rehabilitation protocols, and unmeasured adherence to weight-bearing instructions. The authors noted that although early protocols appeared safe, the absence of high-quality randomized trials means results should be interpreted cautiously.
The researchers concluded that early weight bearing after calcaneal fracture surgery may be a safe alternative to prolonged restriction, but called for randomized controlled trials to define evidence-based rehabilitation guidelines.
