Total calcanectomy for the treatment of chronic calcaneal osteomyelitis

The purpose of this study is to present the surgical and functional results of a total calcanectomy procedure as a foot salvage alternative in patient s with extensive chronic osteomyelitis of the calcaneus. A retrospective re view identified eight patients treated with a total calcanectomy for a chro nic nonhealing plantar ulcer of the heel and osteomyelitis of the calcaneus . The primary diagnosis was insulin-dependent diabetes mellitus (six patien ts), pneumococcal septicemia (one patient), and an open calcaneal fracture (one patient). The average age of the patients was 52 years. Prior procedur es included irrigation and debridement of the heel ulcer (seven patients), partial calcanectomy (three patients), and split thickness skin grafting (t wo patients). The vascular status of each limb was assessed preoperatively, Distal extremity bypass surgery was performed on two patients before calca nectomy. Osteomyelitis of the calcaneus was diagnosed by magnetic resonance imaging alone in three patients, and by technetium/indium scans and magnet ic resonance imaging in five patients. The average follow-up duration was 2 7.3 months (range, 6-57 months). Infection at the plantar heel was controll ed in all patients. In all eight cases the incisions were closed primarily. During a prolonged time of total contact casting to facilitate wound heali ng, one patient developed an anterior tibial ulcer that progressed to osteo myelitis and underwent below-knee amputation. Talonavicular subluxation occ urred as a tate complication in one patient. This was treated with a talona vicular arthrodesis and subsequent bracing for a nonunion. An assessment of functional ambulation was performed on all eight patients. Four patients m aintained the same ambulation level postoperatively in a modified heel-cont ainment orthosis, Two patients decreased one functional ambulation level, a nd one patient decreased two levels. One patient underwent below-knee amput ation and is currently ambulatory with a prothesis. Assessment of ankle str ength and range of motion of the surgical limb demonstrated decreased dorsi flexion and plantarflexion strength and a variable range of motion compared to the contralateral limb. Total calcanectomy is an alternative procedure to transtibial amputation in patients with chronic osteomyelitis of the cal caneus. Eradication of infection and preservation of the functional ambulat ion is achieved.