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Functional Ankle Reconstruction Technique After Total Calcanectomy
1*Mehmet Ali Aydinlar Acibadem University, Acibadem Maslak Hospital, Istanbul, Turkey.
Insights
Total calcanectomy with functional reconstruction offers successful limb salvage for complex calcaneus conditions. This approach minimizes complications and avoids further hindfoot reconstruction, improving patient outcomes.
Area of Science:
- Orthopedic Surgery
- Limb Salvage Procedures
- Foot and Ankle Reconstruction
Background:
- The calcaneus presents treatment challenges due to its anatomy and poor blood supply, making procedures like total calcanectomy difficult.
- Total calcanectomy is rarely recommended but may be necessary for conditions including malignant tumors, chronic osteomyelitis, and severe fractures or ulcers.
- Without functional reconstruction, total calcanectomy can lead to significant functional loss, pain, and further complications.
Purpose of the Study:
- To demonstrate the efficacy of simultaneous total calcanectomy and functional reconstruction techniques.
- To evaluate the outcomes of patients undergoing this combined surgical approach.
Main Methods:
- A retrospective review of three patients who underwent total calcanectomy between 2001 and 2020.
- Indications for surgery included calcaneal osteomyelitis post-trauma (two cases) and chondroblastic osteosarcoma (one case).
Main Results:
- Patients were followed for an average of 116 months.
- No wound complications were observed during the postoperative period or follow-up.
Conclusions:
- Total calcanectomy, when combined with functional reconstruction, is a successful limb salvage strategy.
- Functional reconstruction and rehabilitation, potentially with custom footwear, can enhance outcomes.
- This approach does not appear to increase morbidity or necessitate additional hindfoot bone reconstruction.
Background:
Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would recommend total calcanectomy in various cases of malignant tumors, comminuted fractures, ulcerations of the heel often seen in diabetic patients, and chronic osteomyelitis. After calcanectomy, if functional reconstruction is not performed, the patient will experience loss of function, pain, wound problems, talonavicular dislocations, and additional surgical interventions. In this study, we demonstrate calcanectomy and simultaneous functional reconstruction techniques while discussing the patients' results.
Methods:
We retrospectively evaluated three patients who underwent total calcanectomy between January 1, 2001, and December 31, 2020.Two of these procedures were due to osteomyelitis of the calcaneus after trauma, and one was due to a chondroblastic osteosarcoma of the calcaneus.
Results:
The patients were followed up for an average of 116 months. None of the patients developed problems with their wounds in the postoperative term or during follow-up.
Conclusions:
Total calcanectomy as a surgical method of limb salvage yields successful results. We believe that these results can be improved with functional reconstruction and rehabilitation with custom-made shoes, and the results do not entail additional morbidity or require additional hindfoot bone reconstruction.
