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

Abstract

Diabetic, neuropathic patients are often at risk for ulceration. Those that are temporarily or permanently limited in ambulation and restricted to a supine position are over time very susceptible to heel decubiti. Twelve patients with heel ulceration and calcaneal osteomyelitis who underwent subtotal calcanectomy are presented. Aggressive debridement of all nonviable tissue was coupled with a thorough antibiotic course in all cases. Ten of the 12 were completely healed at follow-up of 13 months. Two patients died of cardiac complications unrelated to their surgery. Postoperatively, the 10 patients were placed in an ankle-foot orthosis combined with a custom-molded shoe. All patients who were ambulatory preoperatively were able to resume their function after surgery. Subtotal calcanectomy is a relatively simple procedure to perform. In the presence of adequate vasculature, it is a good alternative to below-the-knee amputation and the accompanying sequelae.