Surgical algorithms for the treatment of CN of the foot are based almost entirely on level four or five evidence. Uncontrolled retrospective case series and case reports guide the use of exostectomy, fusion, and Achilles tendon lengthening for CN. There is inconclusive evidence concerning timing of treatment and use of different fixation methods. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.

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Managing complications after attempted hind foot and ankle arthrodesis with intramedullary nail fixation is a challenge. This situation becomes more problematic in the patient with diabetes mellitus and multiple comorbidities. Infection and subsequent osteomyelitis can be a devastating, limb threatening complication associated with these procedures. The surgeon must manage both the infectious process and the skeletal instability concurrently. This article provides a literature review and detailed management strategies for a modified technique of employing antibiotic impregnated polymethylmethacrylate-coated intramedullary nailing.