Total Calcanectomy for the Treatment of Calcaneal Osteomyelitis

Total calcanectomy in calcaneal osteomyelitis: An alternative to major amputation

BACKGROUND

Hindfoot ulcers associated with chronic calcaneus osteomyelitis are very difficult to manage and many patients need a limb amputation for resolution. Total calcanectomy can be a salvage procedure for these patients. The purpose of this study is to present our results of total calcanectomy.

METHODS

Retrospective analysis of six patients undergoing total calcanectomy at our institution between 2008 and 2019. Patient data and ambulatory status were analyzed.

RESULTS

In 4 of the 6 patients, infection control and wound closure was achieved with total calcanectomy with follow-up ranging from 1 to 12 years. The 4 patients maintain walking ability. Two major complications: an early death caused by a respiratory infection and a below the knee amputation due to recurrence of the foot infection.

CONCLUSION

Total calcanectomy is an useful procedure for limb salvage in foot ulcers with chronic calcaneus osteomyelitis.

Outcomes of partial and total calcanectomies for the treatment of diabetic heel ulcers complicated with osteomyelitis. A systematic review and meta-analysis

BACKGROUND

Infected diabetic foot ulcers (DFU) complicated with calcaneal osteomyelitis are a real challenge for limb preservation. Very few alternatives to amputation are available, mainly the resection of a part or the totality of the calcaneal bone. Calcanectomies were advanced as limb-sparing procedures in patients with heel osteomyelitis. However, there is a lack of pooled quantitative evidence on their efficacy and complications.

OBJECTIVES

The present systematic review and meta-analysis was conducted to determine the primary outcome of healing rates following partial (PC) and total calcanectomies (TC) in treating calcaneal osteomyelitis due to diabetic heel ulcers. Additionally, secondary outcomes such as secondary TC following PC, secondary below knee amputation (BKA), mortality and the change in the ambulation status were analyzed.

METHODS

Medline, Scopus, Web of science, Cochrane Library and Google Scholar were searched since inception. All types of study design were included. Single case report studies and studies reporting osteomyelitis due to other etiologies than DFU were excluded.

RESULTS

Twenty studies met the inclusion criteria comprising 295 patients with 300 calcanectomies (270 PC and 30 TC). With a mean follow-up period of 29.3±17.7 months, the weighted results were as follows: a) the osteomyelitis healing rate was of 80% (95% CI=0.728 to 0.861, I²=48.3%), b) the rate of secondary total calcanectomy was of 5.4% (95% CI=0.022 to 0.097, I²=7.5%), c) the rate of secondary BKA was of 17.1% (95% CI=0.111 to 0.241, I²=50.6%) with no difference between subgroups of TC and PC, and d) the combined mortality rate of both calcanectomies was of 13.4% (95% CI=0.064 to 0.224, I²=73.6%); however, significant higher mortality was found following TC compared to PC (p<0.0001).

CONCLUSION

Partial and total calcanectomies were found to yield very good healing rates with acceptable complication frequencies. When compared to the reported outcomes of below and above-knee amputations in the literature, calcanectomies could be fairly considered as good alternatives to above ankle amputations.

Total calcanectomy: Treatment for non-healing plantar ulcer with chronic osteomyelitis of the calcaneus

Non-healing neuropathic heel ulcer provides a challenge to salvage the limb from a below-knee amputation. Total calcanectomy can prove a reliable option for limb salvage. Given a well-designed orthosis, patients with total calcanectomy do well at any age. We present two case examples of non-healing neuropathic heel ulcers with chronic osteomyelitis of the calcaneus, which were salvaged with total calcanectomy and returned to all activities of daily living.

De-epithelialized fasciocutaneous turnover flap for recurrent calcaneal wound with osteomyelitis

Recurrent ulcerations of the foot and ankle almost always present a challenge to lower extremity surgeons. Recalcitrant heel ulcerations with osteomyelitis are especially difficult to treat because of the lack of soft tissue coverage. The turnover flap is a simple, fast, and effective treatment method for lower extremity wounds. It is a de-epithelialized fasciocutaneous flap harvested from the adjacent area of the wound. We believe it is an underused technique for advanced wound closure in the lower extremity. It offers several advantages compared with traditional, more difficult to perform, flaps. We have seen an excellent result 18 months after using the turnover flap in a patient with recurrent posterior heel ulceration with calcaneal osteomyelitis.

Management of calcaneal osteomyelitis

Calcaneal osteomyelitis is a complicated clinical scenario, which is often very difficult to treat. It can occur in individuals of any age who are injured or immunocompromised, and once diagnosed, aggressive management should be initiated. Treatment ranges from antibiotics alone to radical debridement or amputation. If there is a delay in both diagnosis and treatment, calcaneal osteomyelitis can be limb threatening or even life threatening.