|
Year |
2007 |
|---|---|
|
Question Number |
90 |
|
Category |
Foot and Ankle |
Question
A 50-year-old patient has type II diabetes mellitus with neuropathy and palpable foot pulses. Examination reveals a 3- x 3-cm heel ulcer with osteomyelitis isolated to the calcaneal tuberosity. Treatment should consist of
1- Syme amputation.
2- below-knee amputation.
3- above-knee amputation.
4- partial calcanectomy.
5- coverage of the ulcer with a free flap.
Figures
Answer (click for answer)
The correct answer is 4- partial calcanectomy
This operation (discussed in Smith et al JBJS 1992) is essentially a partial hindfoot amputation. It is associated with an 83.3% wound healing rate, and a 16.7% rate of more proximal amputation. The majority of patients return to their previous function. Answer 2 and 3 are salvage procedures and inappropriate first steps when the patient has distal pulses. Syme’s amputation involves ankle disarticulation, removal of the malleoli and usage of the heel pad for coverage. Clearly there is an ulcer here so answer 1 is inappropriate. A free flap would likely have little success since neuropathy is present, and the patient would not be able to protect the flap
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