Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy

Chin-Ta Lin, Chi-Yu Chen, Shyi-Gen Chen, Tim-Mo Chen, Shun-Cheng Chang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle. © 2014 JMS.
Original languageEnglish
Pages (from-to)74-78
Number of pages5
JournalJournal of Medical Sciences (Taiwan)
Volume35
Issue number2
DOIs
Publication statusPublished - 2015
Externally publishedYes

Fingerprint

Peripheral Vascular Diseases
Osteomyelitis
Heel
Lower Extremity
Splints
Comorbidity
Knee
Wounds and Injuries
Foot Ulcer
Sedentary Lifestyle
Surgical Casts
Diabetic Foot
Shoes
Postoperative Care
Uremia
Peripheral Arterial Disease
Debridement
Gait
Amputation
Ankle

Keywords

  • Heel ulcer
  • Occlusive peripheral vascular disease
  • Partial calcanectomy
  • sultamicillin
  • vancomycin
  • aged
  • artery occlusion
  • Article
  • calcaneus
  • case report
  • comorbidity
  • debridement
  • diabetes mellitus
  • diabetic foot
  • drug substitution
  • drug withdrawal
  • end stage renal disease
  • follow up
  • human
  • hypertension
  • leg
  • male
  • methicillin resistant Staphylococcus aureus
  • orthopedic surgery
  • osteomyelitis
  • partial calcanectomy
  • plantar ulcer
  • uremia
  • vascular surgery
  • wound care
  • wound closure

Cite this

Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy. / Lin, Chin-Ta; Chen, Chi-Yu; Chen, Shyi-Gen; Chen, Tim-Mo; Chang, Shun-Cheng.

In: Journal of Medical Sciences (Taiwan), Vol. 35, No. 2, 2015, p. 74-78.

Research output: Contribution to journalArticle

@article{0b1829c3a7cb4cd080e6c4d9efcecbab,
title = "Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy",
abstract = "Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle. {\circledC} 2014 JMS.",
keywords = "Heel ulcer, Occlusive peripheral vascular disease, Partial calcanectomy, sultamicillin, vancomycin, aged, artery occlusion, Article, calcaneus, case report, comorbidity, debridement, diabetes mellitus, diabetic foot, drug substitution, drug withdrawal, end stage renal disease, follow up, human, hypertension, leg, male, methicillin resistant Staphylococcus aureus, orthopedic surgery, osteomyelitis, partial calcanectomy, plantar ulcer, uremia, vascular surgery, wound care, wound closure",
author = "Chin-Ta Lin and Chi-Yu Chen and Shyi-Gen Chen and Tim-Mo Chen and Shun-Cheng Chang",
note = "Export Date: 21 March 2016 通訊地址: Chang, S.-C.; Department of Surgery, Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Taiwan 化學物質/CAS: sultamicillin, 76497-13-7; vancomycin, 1404-90-6, 1404-93-9 參考文獻: Chen, S.L., Chen, T.M., Chou, T.D., Chen, S.G., Wang, H.J., The distally based lesser saphenous venofasciocutaneous flap for ankle and heel reconstruction (2002) Plast Reconstr Surg, 110, pp. 1664-1672; Brem, H., Sheehan, P., Rosenberg, H.J., Schneider, J.S., Boulton, A.J., Evidence-based protocol for diabetic foot ulcers (2006) Plast Reconstr Surg, 117, pp. 193S-209S; Singh, N., Armstrong, D.G., Lipsky, B.A., Preventing foot ulcers in patients with diabetes (2005) JAMA, 293, pp. 217-228; Baumhauer, J.F., Fraga, C.J., Gould, J.S., Johnson, J.E., Total calcanectomy for the treatment of chronic calcaneal osteomyelitis (1998) Foot Ankle Int, 19, pp. 849-855; Treiman, G.S., Oderich, G.S., Ashrafi, A., Schneider PA. Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing (2000) J Vasc Surg, 31, pp. 1110-1118; Fraccalvieri, M., Bogetti, P., Verna, G., Carlucci, S., Fava, R., Bruschi, S., Distally based fasciocutaneous sural flap for foot reconstruction (2008) A Retrospective Review of 10 Years Experience. Foot Ankle Int, 29, pp. 191-198; Randall, D.B., Phillips, J., Ianiro, G., Partial calcanectomy for the treatment of recalcitrant heel ulcerations (2005) J am Podiatr Med Assoc, 95, pp. 335-341; Smith, D.G., Stuck, R.M., Ketner, L., Sage, R.M., Pinzur MS. Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot (1992) J Bone Joint Surg Am, 74, pp. 571-576; Bollinger, M., Thordarson, D.B., Partial calcanectomy: An alternative to below knee amputation (2002) Foot Ankle Int, 23, pp. 927-932; Lehmann, S., Murphy, R.D., Hodor, L., Partial calcanectomy in the treatment of chronic heel ulceration (2001) J am Podiatr Med Assoc, 91, pp. 369-372; Geertzen, J.H., Jutte, P., Rompen, C., Salvans, M., Calcanectomy, an alternative amputation? Two case reports (2009) Prosthet Orthot Int, 33, pp. 78-81; Gu, Y.D., Wu, M.M., Li, H.R., Lateral lower leg skin flap (1985) Ann Plast Surg, 15, pp. 319-324; Wee, J.T., Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap (1986) Br J Plast Surg, 39, pp. 327-337; Liu, K., Li, Z., Lin, Y., Cao, Y., The reverse-flow posterior tibial artery island flap: Anatomic study and 72 clinical cases (1990) Plast Reconstr Surg, 86, pp. 312-316; McCraw, J.B., Furlow, L.T., Jr., The dorsalis pedis arterialized flap. A clinical study (1975) Plast Reconstr Surg, 55, pp. 177-185; Morrison, W.A., Crabb, D.M., O’Brien, B.M., Jenkins, A., The instep of the foot as a fasciocutaneous island and as a free flap for heel defects (1983) Plast Reconstr Surg, 72, pp. 56-65; Grabb, W.C., Argenta, L.C., The lateral calcaneal artery skin flap (The lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap) (1981) Plast Reconstr Surg, 68, pp. 723-730; Masquelet, A.C., Beveridge, J., Romana, C., Gerber, C., The lateral supramalleolar flap (1988) Plast Reconstr Surg, 81, pp. 74-81; Masquelet, A.C., Romana, M.C., Wolf, G., Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: Anatomic study and clinical experience in the leg (1992) Plast Reconstr Surg, 89, pp. 1115-1121; Attinger, C.E., Ducic, I., Cooper, P., Zelen, C.M., The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients (2002) Plast Reconstr Surg, 110, pp. 1047-1054; Furukawa, M., Nakagawa, K., Hamada, T., Long-term complications of reconstruction of the heel using a digitorum brevis muscle flap (1993) Ann Plast Surg, 30, pp. 354-358; Lin, S.D., Chou, C.K., Yang, C.C., Lai, C.S., Reconstruction of plantar heel defect using reinnervated, skingrafted flexor digitorum brevis flap (1991) Br J Plast Surg, 44, pp. 109-112; Kuran, I., Turgut, G., Bas, L., Ozkan, T., Bayri, O., Gulgonen, A., Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area (2000) Plast Reconstr Surg, 105, pp. 574-580; Germann, G., Wieczorek, D., Combined pedicle and freetissue transfer to improve functional restoration of the foot: The “backpack principle (1999) J Reconstr Microsurg, 15, pp. 409-413; Rautio, J., Asko-Seljavaara, S., Laasonen, L., H{\"a}rm{\"a}, M., Suitability of the scapular flap for reconstructions of the foot (1990) Plast Reconstr Surg, 85, pp. 922-928; Stevenson, T.R., Greene, T.L., Kling, T.F., Jr., Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap (1987) Plast Reconstr Surg, 79, pp. 982-986; Noever, G., Br{\"u}ser, P., K{\"o}hler, L., Reconstruction of heel and sole defects by free flaps (1986) Plast Reconstr Surg, 78, pp. 345-352; Musharafieh, R., Osmani, O., Musharafieh, U., Saghieh, S., Atiyeh B. Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis of the leg and foot: Review of 22 cases (1999) J Reconstr Microsurg, 15, pp. 239-244; Chen, D., Jupiter, J.B., Lipton, H.A., Li, S.Q., The parascapular flap for treatment of lower extremity disorders (1989) Plast Reconstr Surg, 84, pp. 108-116; Guly{\'a}s, G., M{\'a}t{\'e}, F., Kartik, I.A., Neurovascular island flap from the first web space of the foot to repair a defect over the heel: Case report (1984) Br J Plast Surg, 37, pp. 398-401; Hallock, G.G., Distally based flaps for skin coverage of the foot and ankle (1996) Foot Ankle Int, 17, pp. 343-348; Carsten, C.G., III, Taylor, S.M., Langan, E.M., III, Crane, M.M., Factors associated with limb loss despite a patent infrainguinal bypass graft (1998) Am Surg, 64, pp. 33-37; Edwards, J.M., Taylor, L.M., Jr., Porter, J.M., Limb salvage in end-stage renal disease (ESRD). Comparison of modern results in patients with and without ESRD (1988) Arch Surg, 123, pp. 1164-1168; Adam, D.J., Beard, J.D., Cleveland, T., Bell, J., Bradbury, A.W., Forbes, J.F., Bypass versus angioplasty in severe ischaemia of the leg (BASIL): Multicentre, randomised controlled trial (2005) Lancet, 366, pp. 1925-1934; Faglia, E., Paola, D.L., Clerici, G., Clerissi, J., Graziani, L., Fusaro, M., Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: Prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003 (2005) Eur J Vasc Endovasc Surg, 29, pp. 620-627; Serletti, J.M., Hurwitz, S.R., Jones, J.A., Herrera, H.R., Reading, G.P., Ouriel, K., Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer (1993) J Vasc Surg, 18, pp. 972-978; Ciresi, K.F., Anthony, J.P., Hoffman, W.Y., Bowersox, J.C., Reilly, L.M., Rapp, J.H., Limb salvage and wound coverage in patients with large ischemic ulcers: A multidisciplinary approach with revascularization and free tissue transfer (1993) J Vasc Surg, 18, pp. 648-653; Tukiainen, E., Kallio, M., Lep{\"a}ntalo, M., Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Longterm outcome (2006) Ann Surg, 244, pp. 949-957; Nather, A., Chionh, S.B., Han, A.Y., Chan, P.P., Nambiar, A., Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers (2010) Ann Acad Med Singapore, 39, pp. 353-358; Gaenslen, F.J., Split-heel approach in osteomyelitis of the os calcis (1931) J Bone Joint Surg, 13, pp. 759-772; Baravarian, B., Menendez, M.M., Weinheimer, D.J., Lowery, C., Kosanovich, R., Vidt, L., Subtotal calcanectomy for the treatment of large heel ulceration and calcaneal osteomyelitis in the diabetic patient (1999) J Foot Ankle Surg, 38, pp. 194-202",
year = "2015",
doi = "10.4103/1011-4564.156016",
language = "English",
volume = "35",
pages = "74--78",
journal = "Journal of Medical Sciences",
issn = "1011-4564",
publisher = "國防醫學院",
number = "2",

}

TY - JOUR

T1 - Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy

AU - Lin, Chin-Ta

AU - Chen, Chi-Yu

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

AU - Chang, Shun-Cheng

N1 - Export Date: 21 March 2016 通訊地址: Chang, S.-C.; Department of Surgery, Division of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Taiwan 化學物質/CAS: sultamicillin, 76497-13-7; vancomycin, 1404-90-6, 1404-93-9 參考文獻: Chen, S.L., Chen, T.M., Chou, T.D., Chen, S.G., Wang, H.J., The distally based lesser saphenous venofasciocutaneous flap for ankle and heel reconstruction (2002) Plast Reconstr Surg, 110, pp. 1664-1672; Brem, H., Sheehan, P., Rosenberg, H.J., Schneider, J.S., Boulton, A.J., Evidence-based protocol for diabetic foot ulcers (2006) Plast Reconstr Surg, 117, pp. 193S-209S; Singh, N., Armstrong, D.G., Lipsky, B.A., Preventing foot ulcers in patients with diabetes (2005) JAMA, 293, pp. 217-228; Baumhauer, J.F., Fraga, C.J., Gould, J.S., Johnson, J.E., Total calcanectomy for the treatment of chronic calcaneal osteomyelitis (1998) Foot Ankle Int, 19, pp. 849-855; Treiman, G.S., Oderich, G.S., Ashrafi, A., Schneider PA. Management of ischemic heel ulceration and gangrene: An evaluation of factors associated with successful healing (2000) J Vasc Surg, 31, pp. 1110-1118; Fraccalvieri, M., Bogetti, P., Verna, G., Carlucci, S., Fava, R., Bruschi, S., Distally based fasciocutaneous sural flap for foot reconstruction (2008) A Retrospective Review of 10 Years Experience. Foot Ankle Int, 29, pp. 191-198; Randall, D.B., Phillips, J., Ianiro, G., Partial calcanectomy for the treatment of recalcitrant heel ulcerations (2005) J am Podiatr Med Assoc, 95, pp. 335-341; Smith, D.G., Stuck, R.M., Ketner, L., Sage, R.M., Pinzur MS. Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot (1992) J Bone Joint Surg Am, 74, pp. 571-576; Bollinger, M., Thordarson, D.B., Partial calcanectomy: An alternative to below knee amputation (2002) Foot Ankle Int, 23, pp. 927-932; Lehmann, S., Murphy, R.D., Hodor, L., Partial calcanectomy in the treatment of chronic heel ulceration (2001) J am Podiatr Med Assoc, 91, pp. 369-372; Geertzen, J.H., Jutte, P., Rompen, C., Salvans, M., Calcanectomy, an alternative amputation? Two case reports (2009) Prosthet Orthot Int, 33, pp. 78-81; Gu, Y.D., Wu, M.M., Li, H.R., Lateral lower leg skin flap (1985) Ann Plast Surg, 15, pp. 319-324; Wee, J.T., Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: Preliminary report of a new fasciocutaneous flap (1986) Br J Plast Surg, 39, pp. 327-337; Liu, K., Li, Z., Lin, Y., Cao, Y., The reverse-flow posterior tibial artery island flap: Anatomic study and 72 clinical cases (1990) Plast Reconstr Surg, 86, pp. 312-316; McCraw, J.B., Furlow, L.T., Jr., The dorsalis pedis arterialized flap. A clinical study (1975) Plast Reconstr Surg, 55, pp. 177-185; Morrison, W.A., Crabb, D.M., O’Brien, B.M., Jenkins, A., The instep of the foot as a fasciocutaneous island and as a free flap for heel defects (1983) Plast Reconstr Surg, 72, pp. 56-65; Grabb, W.C., Argenta, L.C., The lateral calcaneal artery skin flap (The lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap) (1981) Plast Reconstr Surg, 68, pp. 723-730; Masquelet, A.C., Beveridge, J., Romana, C., Gerber, C., The lateral supramalleolar flap (1988) Plast Reconstr Surg, 81, pp. 74-81; Masquelet, A.C., Romana, M.C., Wolf, G., Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: Anatomic study and clinical experience in the leg (1992) Plast Reconstr Surg, 89, pp. 1115-1121; Attinger, C.E., Ducic, I., Cooper, P., Zelen, C.M., The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients (2002) Plast Reconstr Surg, 110, pp. 1047-1054; Furukawa, M., Nakagawa, K., Hamada, T., Long-term complications of reconstruction of the heel using a digitorum brevis muscle flap (1993) Ann Plast Surg, 30, pp. 354-358; Lin, S.D., Chou, C.K., Yang, C.C., Lai, C.S., Reconstruction of plantar heel defect using reinnervated, skingrafted flexor digitorum brevis flap (1991) Br J Plast Surg, 44, pp. 109-112; Kuran, I., Turgut, G., Bas, L., Ozkan, T., Bayri, O., Gulgonen, A., Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area (2000) Plast Reconstr Surg, 105, pp. 574-580; Germann, G., Wieczorek, D., Combined pedicle and freetissue transfer to improve functional restoration of the foot: The “backpack principle (1999) J Reconstr Microsurg, 15, pp. 409-413; Rautio, J., Asko-Seljavaara, S., Laasonen, L., Härmä, M., Suitability of the scapular flap for reconstructions of the foot (1990) Plast Reconstr Surg, 85, pp. 922-928; Stevenson, T.R., Greene, T.L., Kling, T.F., Jr., Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap (1987) Plast Reconstr Surg, 79, pp. 982-986; Noever, G., Brüser, P., Köhler, L., Reconstruction of heel and sole defects by free flaps (1986) Plast Reconstr Surg, 78, pp. 345-352; Musharafieh, R., Osmani, O., Musharafieh, U., Saghieh, S., Atiyeh B. Efficacy of microsurgical free-tissue transfer in chronic osteomyelitis of the leg and foot: Review of 22 cases (1999) J Reconstr Microsurg, 15, pp. 239-244; Chen, D., Jupiter, J.B., Lipton, H.A., Li, S.Q., The parascapular flap for treatment of lower extremity disorders (1989) Plast Reconstr Surg, 84, pp. 108-116; Gulyás, G., Máté, F., Kartik, I.A., Neurovascular island flap from the first web space of the foot to repair a defect over the heel: Case report (1984) Br J Plast Surg, 37, pp. 398-401; Hallock, G.G., Distally based flaps for skin coverage of the foot and ankle (1996) Foot Ankle Int, 17, pp. 343-348; Carsten, C.G., III, Taylor, S.M., Langan, E.M., III, Crane, M.M., Factors associated with limb loss despite a patent infrainguinal bypass graft (1998) Am Surg, 64, pp. 33-37; Edwards, J.M., Taylor, L.M., Jr., Porter, J.M., Limb salvage in end-stage renal disease (ESRD). Comparison of modern results in patients with and without ESRD (1988) Arch Surg, 123, pp. 1164-1168; Adam, D.J., Beard, J.D., Cleveland, T., Bell, J., Bradbury, A.W., Forbes, J.F., Bypass versus angioplasty in severe ischaemia of the leg (BASIL): Multicentre, randomised controlled trial (2005) Lancet, 366, pp. 1925-1934; Faglia, E., Paola, D.L., Clerici, G., Clerissi, J., Graziani, L., Fusaro, M., Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: Prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003 (2005) Eur J Vasc Endovasc Surg, 29, pp. 620-627; Serletti, J.M., Hurwitz, S.R., Jones, J.A., Herrera, H.R., Reading, G.P., Ouriel, K., Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer (1993) J Vasc Surg, 18, pp. 972-978; Ciresi, K.F., Anthony, J.P., Hoffman, W.Y., Bowersox, J.C., Reilly, L.M., Rapp, J.H., Limb salvage and wound coverage in patients with large ischemic ulcers: A multidisciplinary approach with revascularization and free tissue transfer (1993) J Vasc Surg, 18, pp. 648-653; Tukiainen, E., Kallio, M., Lepäntalo, M., Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Longterm outcome (2006) Ann Surg, 244, pp. 949-957; Nather, A., Chionh, S.B., Han, A.Y., Chan, P.P., Nambiar, A., Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers (2010) Ann Acad Med Singapore, 39, pp. 353-358; Gaenslen, F.J., Split-heel approach in osteomyelitis of the os calcis (1931) J Bone Joint Surg, 13, pp. 759-772; Baravarian, B., Menendez, M.M., Weinheimer, D.J., Lowery, C., Kosanovich, R., Vidt, L., Subtotal calcanectomy for the treatment of large heel ulceration and calcaneal osteomyelitis in the diabetic patient (1999) J Foot Ankle Surg, 38, pp. 194-202

PY - 2015

Y1 - 2015

N2 - Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle. © 2014 JMS.

AB - Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle. © 2014 JMS.

KW - Heel ulcer

KW - Occlusive peripheral vascular disease

KW - Partial calcanectomy

KW - sultamicillin

KW - vancomycin

KW - aged

KW - artery occlusion

KW - Article

KW - calcaneus

KW - case report

KW - comorbidity

KW - debridement

KW - diabetes mellitus

KW - diabetic foot

KW - drug substitution

KW - drug withdrawal

KW - end stage renal disease

KW - follow up

KW - human

KW - hypertension

KW - leg

KW - male

KW - methicillin resistant Staphylococcus aureus

KW - orthopedic surgery

KW - osteomyelitis

KW - partial calcanectomy

KW - plantar ulcer

KW - uremia

KW - vascular surgery

KW - wound care

KW - wound closure

U2 - 10.4103/1011-4564.156016

DO - 10.4103/1011-4564.156016

M3 - Article

VL - 35

SP - 74

EP - 78

JO - Journal of Medical Sciences

JF - Journal of Medical Sciences

SN - 1011-4564

IS - 2

ER -