The dilemma of painful old os calcis fractures.

This study of 16 patients (17 amputations) draws attention to intractable pain as a rare, but not previously emphasized, sequela of os calcis fracture. The fracture remained painful despite, in many cases, exhaustive measures to relieve symptoms. The majority of patients still had pain even after amputation and revision, suggesting the development of a regional (phantom) pain syndrome. Patients should be advised that severe os calcis fractures may not heal sufficiently to stabilize the foot for 18-24 months. Patients who continue to complain of pain following treatment of a fracture of the os calcis should be carefully evaluated in a pain management clinic. Since in some patients the pain may not be entirely organic in origin, amputation would not solve the problem. In the present series amputation did not always relieve pain and also made prosthetic fitting difficult.