Is total calcanectomy an effective alternative to below-knee amputation in patients with chronic Heel wounds?

Abstract

Non-healing calcaneal ulcers are a challenging problem to treat. Total calcanectomy (TC) is a limb salvage alternative to below-knee amputation (BKA) but has traditionally been underutilized. We aimed to assess the surgical and functional outcomes of TC. We hypothesized that TC does not lead to improved ambulation or quality of life when compared to BKA. A retrospective review of patients who underwent TC from 2011 to 2021 at our limb-salvage center was conducted. Patient demographics, comorbidities, surgical factors, complications and long-term outcomes were recorded. Primary outcomes included early postoperative complications, secondary BKA, ambulatory status, and mortality. Fifteen TCs in 14 patients were identified. One patient underwent bilateral calcanectomies. Average age and body mass index was 62.3 years and 30.9 kg/m2, respectively. Comorbidities included diabetes mellitus in 12 patients (85.7%), peripheral vascular disease in 7 patients (50.0%), and active smoking in 7 patients (50.0%). Indication for TC was calcaneal osteomyelitis (93.3%) or calcaneal fracture (6.7%). Complications included hematoma (6.7%), wound dehiscence (13.3%), and wound infection (26.7%). Secondary BKA was performed in 9 patients (60.0%). At mean follow-up of 13.8 months, 5 patients (35.7%) were ambulatory (4 patients had undergone secondary BKA and 1 patient used a custom-molded orthosis). TC may be considered as an alternative to BKA in non-ambulatory patients with chronic heel ulcers. BKA is a better option in patients who wish to have a more active ambulatory lifestyle.

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