Calcanectomy Definition, Procedure, Surgery | Partial vs. Total calcanectomy surgery

What is Calcanectomy?

The calcaneus is a component of the hindfoot that is known for its important function in weight-bearing as well as movement. When the calcaneus becomes infected or osteomyelitis develops, it presents a special challenge. The majority of the calcaneus' blood supply comes from nourishing branches of the peroneal and posterior tibial arteries. These arteries are located in the calf muscle. 

Conditions that impact the microvasculature, such as diabetes mellitus and peripheral vascular disease, might make the calcaneus susceptible to damage. It is essential to eradicate infections in order to prevent related morbidities and additional complications. A calcanectomy can be performed on either a section of the calcaneus known as a Partial Calcanectomy or on the entire calcaneus known as a total calcanectomy.

Patients who have neuropathy have a greater chance of developing heel ulcerations, and these ulcerations are more likely to become visible in patients who are obese and have increased calcaneal plantar strains. In the event that heel ulcers do not appear, the subsequent clinical manifestation that may take place over time is the growth of hammertoes or claw toes as a result of flexor substitution in the context of a weaker triceps surae. 

Insensate patients with skeletal abnormalities may develop nail and/or forefoot ulcerations that require treatment and could lead to amputation. Calcaneal ulcerations are extremely dangerous complications that can arise in diabetic patients. It is difficult to treat heel ulceration that progresses to osteomyelitis, and there are few reconstructive options available. A full or partial calcanectomy may be required in certain circumstances.

Calcanectomy Definition:

A total calcanectomy is a procedure to completely remove calcaneus in patients with chronic osteomyelitis of the calcaneus. 

A partial calcanectomy, often known as a PC, is a well-established limb-salvage technique that is used for the treatment of profound heel ulceration in conjunction with calcaneal osteomyelitis. In partial calcanectomy, at least one-third of the calcaneus is removed.

When osteomyelitis or a big, non-healing wound is present over the heel, a partial calcanectomy is considered for surgical therapy. These lesions are usually neuropathic ulcers on the plantar area of the heel or chronic decubitus ulcers on the back of the heel.

Procedure:

Put the patient in the prone position, and depending on the size of any overlaying ulcer, begin the incision around 2 to 4 centimeters proximal to where the Achilles tendon penetrates into the heel bone. The incision goes all the way down to the calcaneocuboid joint. To incorporate ulcers or sinus tracts, the incision can extend medially or laterally. To preserve the skin's blood supply, the dissection is carried all the way down to the bone. This results in full-thickness soft tissue flaps. 

It is important to locate and protect critical neurovascular bundles as well as tendons in the middle and the side of the body. If the Achilles tendon is extensively infected or engaged in the heel ulcer, it should be debrided and released. The Achilles tendon is conserved if it is unaffected by illness and remains intact. It is more likely that the patient will be able to walk again after surgery if the Achilles tendon remains intact.

Surgery Principles

After reviewing pertinent imaging results, the choice between a partial and a total calcanectomy should be taken. In the case of persistent osteomyelitis, radiographs may show evidence of bone resorption, particularly in the posterior metaphyseal equivalent region of the bone. Osteomyelitis can be identified and the depth in the affected bone can be determined using advanced imaging techniques like MRI or nuclear imaging.

If preoperative imaging examinations reveal partial involvement of the calcaneus, a partial calcanectomy is advised. This procedure is effective in removing all diseased bone while preserving the talocalcaneal and calcaneocuboid articulations, but only if the anterior articular regions of the calcaneus are spared. Total calcanectomy is the preferred surgery if the disease process seems to be affecting the entire bone or if the patient has had a partial calcanectomy in the past with recurrent infection or ulceration. If more widespread involvement is found intraoperatively, the surgeon should always be prepared to conduct a total calcanectomy. 

Partial vs. Total calcanectomy surgery

A total calcanectomy is a procedure to completely remove calcaneus in patients with chronic osteomyelitis. A partial calcanectomy, often known as a PC, is a well-established limb-salvage technique that is used for the treatment of profound heel ulceration. In partial calcanectomy, at least one-third of the calcaneus is removed. When osteomyelitis or a big, non-healing wound is present over the heel, a partial calcanectomy is performed.