Management of severe diabetic heel infection

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Management of severe diabetic heel infection

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Thursday, 12 November 2009 05:58

Partial calcanectomy with partial excision of tendo achilis in management of severe diabetic heel infection.

Prof. Ayman Salem Professor of vascular Surgery, Zagazig University

Abstract

The purpose of the study was to present the surgical and functional results of partial calcanectomy with Partial excision of tendoachillis procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus extending to the lower leg.

Osteomyelitis of the calcaneus was diagnosed by Plain X ray in twelve patients and by magnetic resonance imaging in six patients.

Correction of anemia and diabetes took the priority in the peri-operative period. Elevation of the haemoglobin concentration to above 11gm% and control of blood glucose level all time below 150 mg %.

The average follow-up duration was 27.3 months (range, 6-57 months)

Infection at the plantar heel was controlled in all patients

During a prolonged time of total contact casting to facilitate wound healing. Three patient developed an anterior tibial ulcer that progressed to osteomyelitis and underwent below-knee amputation Talonavicular subluxation occurred as a late complication in one patient. This was treated with a talonavicular arthrodesis and subsequent bracing for a nonunion.

- partial calcanectomy with Partial excision of tedoachillis procedure is an alternative procedure to transtibial amputation in patients with chronic tendoachillis infection and osteomyelitis of the calcaneus.

Eradication of infection and preservation of the functional ambulation is achieved .

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