Lower Extremity Function following Partial Calcanectomy in High-Risk Limb Salvage Patients

Abstract

Partial calcanectomy (PC) is an established limb salvage procedure for treatment of deep heel ulceration with concomitant calcaneal osteomyelitis. The purpose of this study is to determine if a relationship exists between the amount of calcaneus removed during PC and the resulting lower extremity function and limb salvage outcomes. Consecutive PC patients were retrospectively divided into two cohorts defined by the amount of calcaneus resected before wound closure: patients in cohort 1 retained = 50% of calcaneus, while patients in cohort 2 underwent resection of >50% of the calcaneus. The Lower Extremity Function Scale (LEFS) was used to assess postoperative lower extremity function. The average amount of calcaneus resected was 13% ± 9.2 (1–39%) and 74% ± 19.5 (51–100) in cohorts 1 and 2, respectively (P < 0.0001). Below knee amputation was performed in 7 (28%) and 5 (29%) of subjects in cohorts 1 and 2, respectively (P = 1.0). The average LEFS score was 33.9 ± 15.0 for subjects in cohort 1 and 36.2 ± 19.9 for the subjects cohort 2 (P = 0.8257) which correlates to “moderate to quite a bit of difficulty.” Our study suggests that regardless of the amount of calcaneus resected, PC provides a viable treatment option for high-risk patients with calcaneal osteomyelitis.

Surgical Treatment and Outcomes of Calcaneal Osteomyelitis in Adults: A Systematic Review

“…In the study by Oliver et al (2015), 42 patients with calcaneal osteomyelitis and partial calcanectomy were included 11. The patients were divided into two cohorts with a resection of the calcaneum of <50% and >50%.…”

“…Nine studies described treatment in a single stage 9,10,13,14,16,18,21,23,24. Only 2 papers describe 2 stage procedures 11,20. In both papers, skin closure was performed separately after the first stage bone excision.…”

“…Regarding bone management results, bone preserving and more radical procedures seem to have comparable relapse and recurrence rates of osteomyelitis, although functional results may be better with less radical surgeries 11,13,14. However, the functional outcome was not always specified.…”

Combination of Open Subtotal Calcanectomy and Stabilization With External Fixation as Limb Salvage Procedure in Hindfoot-Infected Diabetic Foot Ulcers

“…4 Despite difficulties in obtaining a successful conservative treatment, several clinical studies have recently shown the possibility of the limb salvage procedure. 12-14 Partial calcanectomy surgical procedure was described for the first time in 1896. 15 Over the past 25 years, several articles were published describing this procedure as a salvage treatment.…”

A Case of Chronic Limb-Threatening Ischemia with Heel Ulcers Cured by Revascularization and Partial Calcanectomy

“…with large heel ulcers and calcaneus OM. 8) In fact, it has also been reported that proper revascularization and PC are effective. 9) We could minimize the deterioration of our patient s quality of life by treating her with PC and rehabilitation.…”