challenge of treatment calcaneal osteomyelitis: surgical options and outcome of a case series
Background: Calcaneal osteomyelitis accounts for 3% to 10% of all bone infections and frequently results from trauma, surgical complications, or diabetic foot ulcers. Due to the high mortality rates associated with transtibial and transfemoral amputations, limb salvage through calcaneal preservation is prioritized. However, the anatomical complexity of the hindfoot and limited local soft tissue availability present significant challenges for skeletal and tegumentary reconstruction.
Objective: This study evaluates the surgical techniques and clinical outcomes of a consecutive case series involving 25 patients treated for calcaneal osteomyelitis using a combined bone and soft tissue management approach.
Key Points: Between 2005 and 2018, 25 patients underwent surgical intervention for calcaneal osteomyelitis, primarily following fracture-related infections (56%). Management involved a lateral L-shaped incision to facilitate thorough debridement or partial calcanectomy while preserving the Achilles tendon insertion and weight-bearing surfaces. Microbiological analysis identified Staphylococcus aureus (31%) and Candida albicans (17%) as the most prevalent pathogens. Soft tissue defects were addressed through primary closure, local rotational flaps, or skin grafting. At one-year follow-up, infection eradication was achieved in 88% of patients. Postoperative complications occurred in 36%, including wound leakage and a 12% recurrence rate requiring reoperation. Functional outcomes were favorable, with 88% of patients achieving unaided ambulation and 88% reporting a pain-free status.
Conclusion: Chronic calcaneal osteomyelitis requires a multidisciplinary strategy to ensure infection eradication and functional preservation. Single-stage partial calcaneal resection combined with targeted soft tissue reconstruction serves as an effective alternative to major amputation, maintaining high rates of limb salvage and patient mobility.
