Osteomyelitis of the Calcaneus

Abstract

Osteomyelitis of the calcaneus most commonly results from contiguous spread of infection from an adjacent decubitus heel ulcer or complicated surgical wound. Other routes of infection include hematogenous spread or direct inoculation from a puncture wound. The optimal treatment plan for an individual patient with calcaneal osteomyelitis is dependent on the extent of bone involvement, size, and location of the soft tissue deficit, local circulation, viability of the surrounding soft tissues, patient age, and anticipated future activity level. Medical management is needed for nearly all cases of calcaneal osteomyelitis regardless of surgical intervention unless the leg is amputated. This chapter will primarily focus on surgical decision making including various approaches for debridement of the calcaneus and wound coverage options. Surgical treatment generally entails one of three different approaches depending on the clinical circumstances including cortical windowing with internal medullary debridement, wound excision with cortical debridement, or partial calcanectomy with flap closure. Clinical examples are presented to highlight our surgical treatment protocols including patient selection criteria, surgical technique tips, staging guidelines, flap design, and typical postoperative care plans including postoperative bracing options.