The Journal of Bone and Joint Surgery, Vol 74, Issue 4 571-576, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot
DG Smith, RM Stuck, L Ketner, RM Sage and MS Pinzur
University of Washington, Seattle.
Twelve patients who had a large ulceration over the heel were managed with
a partial calcanectomy, in lieu of a below-the-knee amputation, after
unsuccessful non-operative treatment of the ulcer. Only patients who had an
ankle-arm index (the ratio of blood pressure at the ankle to the brachial
blood pressure) of more than 0.45, a transcutaneous PO2 of more than
twenty-eight millimeters of mercury (3.7 kilopascals), a level of albumin
of more than 3.0 grams per deciliter (thirty grams per liter), and a total
lymphocyte count of more than 1500 were managed with a partial
calcanectomy. The primary diagnosis was diabetes in seven patients,
peripheral vascular disease in three, quadriplegia in one, and
myelodysplasia in one. The duration of follow-up averaged thirty-three
months and ranged from seven to sixty-four months. The wound healed after
the partial calcanectomy in ten of the twelve patients. Nine of these ten
patients maintained the level of mobility that they had had preoperatively.
(One patient was unable to walk because he was quadriplegic before the
operation). The wound did not heal in two patients, and those patients
ultimately had a below-the-knee amputation and a decrease of one grade on
the scale that was used to evaluate walking ability.
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