Subtotal calcanectomy for the treatment of large heel ulceration and calcaneal osteomyelitis in the diabetic patient

Calcanectomy: Avoiding major amputation in the presence of calcaneal osteomyelitis—A case series

“…A retrospective review of partial calcanectomy in a DM cohort study [5] found a limb salvage rate at one year was excellent. 12 patients were reviewed, with both ambulatory and nonambulatory patients included.…”

“…This is not infrequent in patients with peripheral neuropathy, who have a loss of protective sensation (LOPS) and often have xeroderma and reduced elasticity of the skin [3]. Neuropathic ulcerations overlying the calcaneus are more common in the elderly with contractures [4] and those with profound neuropathy and vascular disease [5]. They can be complicated by osteomyelitis of the calcaneus [6], which is a potentially devastating condition.…”

Heel Ulcer and Blood Flow

“…Instead, a deep, infected, or gangrenous ulcer located in the posterior portion of the heel can be treated with surgical removal of infectious tissue, whereas the remaining portion of the calcaneal body still permits proper weightbearing. 8,9 The peculiar anatomic distribution of arterial supply to the heel region can impair wound healing.…”

Gaenslen’s Split Heel Approach for the Treatment of Chronic Osteomyelitis of the Calcaneus: A series of three cases

“…In the presence of adequate vasculature, it is a good alternative to below-the-knee amputation and the accompanying sequel even for patients with diabetic neuropathy. 9 Studies suggest that resection of the major portion of the calcaneus does not prevent the patient from bearing weight on the foot and subtotal calcanectomy is superior to total calcanectomy because it provides a more stable foot. 10,11 So excision of calcaneum to different extents as required in every different case could give expected result.…”