Lower extremity function following partial calcanectomy in high-risk limb salvage patients.

Noah G Oliver,Christopher E Attinger,John S Steinberg,Kelly Powers,Karen K Evans,Paul J Kim

doi:10.1155/2015/432164

Noah G Oliver, Christopher E Attinger + Show 4 more

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https://doi.org/10.1155/2015/432164

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Abstract

Partial calcanectomy (PC) is an established limb salvage procedure for treatment of deep heel ulceration with concomitant calcaneal osteomyelitis. The purpose of this study is to determine if a relationship exists between the amount of calcaneus removed during PC and the resulting lower extremity function and limb salvage outcomes. Consecutive PC patients were retrospectively divided into two cohorts defined by the amount of calcaneus resected before wound closure: patients in cohort 1 retained = 50% of calcaneus, while patients in cohort 2 underwent resection of >50% of the calcaneus. The Lower Extremity Function Scale (LEFS) was used to assess postoperative lower extremity function. The average amount of calcaneus resected was 13% ± 9.2 (1–39%) and 74% ± 19.5 (51–100) in cohorts 1 and 2, respectively (P < 0.0001). Below knee amputation was performed in 7 (28%) and 5 (29%) of subjects in cohorts 1 and 2, respectively (P = 1.0). The average LEFS score was 33.9 ± 15.0 for subjects in cohort 1 and 36.2 ± 19.9 for the subjects cohort 2 (P = 0.8257) which correlates to “moderate to quite a bit of difficulty.” Our study suggests that regardless of the amount of calcaneus resected, PC provides a viable treatment option for high-risk patients with calcaneal osteomyelitis.

Highlights

Partial calcanectomy (PC) is a well-established treatment for heel ulcers with concomitant calcaneal osteomyelitis (OM) [1,2,3]
A much larger subsequent study showed that even though below-knee amputation (BKA) amputees with the same comorbidities were able to achieve a 78% ambulatory rate, nonambulators were unable to handle the complexity of using a prosthesis and remained wheelchair bound [21]
Lower extremity function and limb salvage appeared to be similar in our patients regardless of the amount of calcaneus resected

Summary

Introduction

Partial calcanectomy (PC) is a well-established treatment for heel ulcers with concomitant calcaneal osteomyelitis (OM) [1,2,3]. Heel ulcers usually result from a combination of chronic pressure, neuropathy, and peripheral arterial disease in patients with multiple high-risk comorbidities including diabetes [1,2,3]. A recent study found that major LE amputations were performed in 52% of patients with OM of the heel [4]. Treatment goals in these challenging and limb threatening cases include eradication of infection, durable soft-tissue coverage, and maximizing lower extremity function [8, 9]. Since its original description by Gaenslen in 1931 [10], the PC has demonstrated the ability to accomplish these goals and provide a viable treatment alternative to amputation for patients with heel ulcers and calcaneal OM [1,2,3, 11,12,13,14,15,16,17,18]

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