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I am a solo and independent roofer, so I don't have Worker's Compensation. Last month, I fell from a ladder and broke my heel badly enough to need surgery. Without disability insurance or Worker's Comp, I'm on my own to get better and get back to work. What are my chances of recovery after an injury like this?

The demands of your job (climbing ladders, walking on uneven or slanted rooftops) create a unique challenge to recovery from an injury of this type. If you needed surgery, that suggests the fracture was displaced (bones separated) and/or comminuted (many bone fragments). Recovery often depends on your age, general health, use of tobacco products, and psychosocial factors such as motivation to return-to-work. Studies show that traumatic injuries are slower to heal in patients who have diabetes, heart disease, and/or who smoke or use other tobacco products. Older adults tend to heal more slowly. Good nutrition is also important in healing from musculoskeletal injuries. Studies show a high rate of complications following surgery for calcaneal fractures. Patients often develop infections, poor wound healing and/or experience disabling pain requiring additional surgery. Sometimes the surgeon has to remove the hardware (plates, screws, wires) that is holding the bone fragments together. In other cases, it may become necessary to fuse the ankle, a procedure called arthrodesis. Pain and ankle instability are the two major reasons for ankle fusion. With a fusion, walking on the rooftops of homes and buildings would be a much greater challenge. If you did have Worker's Compensation status, ankle fusion would be enough to claim a disability. Your surgeon will be able to give you some predictions based on the individual factors and variables discussed here. A recent study from Duke University Medical Center reported excellent long-term results following surgery for displaced calcaneal injuries. The majority of their 73 patients (82 per cent) went back to work (though they did not report specific job types). Only three per cent required fusion later. Better understanding of this injury and the surgical procedure along with improved surgical technique mean improved outcomes for patients today with this injury.

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