Partial calcanectomy: an alternative to below knee amputation

Twenty-two patients with non-healing wounds over the heel, with or without underlying osteomyelitis, had been unresponsive to conservative therapy. They were treated with a partial calcanectomy as an alternative to below knee amputation. Nine patients had a primary diagnosis of diabetes. Thirteen patients had osteomyelitis from various other causes. All patients had a minimum 12 months follow-up except three who were deceased. Average follow-up was 27 months (range, two to 80 months). All patients healed their wounds with no patient requiring subsequent below knee amputation. Twelve patients had delayed wound healing including all nine with diabetes. Eleven additional procedures were performed on the heels of nine patients. Of the 18 patients available for follow-up at this time (four patients had died), all were satisfied with their surgery. Twelve were using orthoses while six used athletic shoes. Pain with activity was described as none in six, mild in 10, moderate in one, and severe in one patient with RSD. Ability to walk improved in seven, did not change in 10, and decreased in one (due to unrelated problems with his diabetes). Only one patient would have chosen a below knee amputation in hindsight due to pain in his lower leg and ankle. Partial calcanectomy is a viable alternative to below knee amputation with a high satisfaction level for patients with large heel ulcers with or without osteomyelitis.