Preserving the Diabetic Foot

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What Research Reveals About Sub-Total Calcanectomies

Performing sub-total calcanectomies on the high risk diabetic foot is controversial in the medical literature.

In 1981, Crandall and Wagner reviewed the results of 29 patients (31 heels) who underwent a partial calcanectomy.2 Only 14 healed primarily. Smith et. al., reviewed a subgroup of 10 diabetics that underwent sub-total calcanectomy with an average follow-up of 122 weeks.3 Thirty percent of the patients failed to heal successfully while three eventually had amputations. On the other hand, Baravarian reported on 12 patients who received sub-total calcanectomies, of which 10 completely healed.4

Though partial calcanectomies have various reports of success in the literature, ensuring careful patient selection and preoperative planning are absolute musts with this patient population. Clear indications for performing a calcanectomy include: osteomyelitis, failure of previous conservative care and any defect that would otherwise lead to a below knee amputation. Patients who have ischemia to the posterior heel (as evidenced by arteriography), extensive soft tissue infection with osteomyeltis, and those who are significantly medically compromised are not appropriate candidates for this procedure. As Crandall and Wagner point out, a partial calcanectomy does not change the level of amputation when a BKA is the only other choice.2

With the aid of hyperbaric oxygen therapy, a STSG, adjunctive wound care and
accommodative shoes, Patient #2 was able to heal a TMA procedure (as shown above).
Four days after undergoing a LisFranc’s joint arthrodesis, Patient #2 returned to the emergency room with a painful blister at the distal forefoot (as shown above) while being immobilized in a cast.
Patient #2 had a rocker bottom deformity with a prominent cuboid plantarly due to Charcot osteoarthropathy.
Four days after undergoing a LisFranc’s joint arthrodesis, Patient #2 returned to the emergency room with a painful blister at the distal forefoot (as shown above) while being immobilized in a cast.
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Author(s): 
Jonathan E. Moore, DPM, MS, Lawrence Harkless, DPM and George Liu, DPM

Armed with the latest research and their own intriguing case studies, these authors take a closer look at limb salvage procedures and assess whether they are viable
alternatives to amputation.

By Jonathan E. Moore, DPM, MS, Lawrence Harkless, DPM and George Liu, DPM

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