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A - Calcaneal osteomyelitis in MRI. B - Pre-operative photograph with sinus tract (arrow).
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The MRI confirmed calcaneal osteomyelitis (Fig. 1a). Even though the flap was totally viable and healed well, the sinus drainage recurred a few weeks afterward (Fig. 1b).
Calcaneal defect after extensive debridement - approximately 4.5 cm of bone gap.
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This required the removal of a significant amount of calcaneal bone (Fig. 2).
A - Intra-operative photograph after harvest of composite flap. B - Final aspect of the flap just before inset. C - Tibio-tarsal joint fusion.
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The fibula was transected distally at approximately 6 cm from the lateral malleolus with a vascular pedicle of 7 cm (Fig. 3a). The final dimensions of the flap (Fig. 3b) were 4.5 x 1.5 x 1.2 (bone) and 4 x 1.5 x 0.5 cm (muscle component). The Achilles tendon was contracted secondary to several episodes of distal tendinitis and was elongated using a modification of the Hoke method (semi-open triple hemi-section), and the tibiotarsal joint was fused at 90 degrees with the use of a Steinmann pin (Fig. 3c).
A - Radiographic appearance of the reconstructed defect 9 months postoperatively. B - Photography of the foot 12 months post-operatively.
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Nine months post-operatively bone union was evident radiographically (Fig. 4a) with no signs of recurrent infection or avascular necrosis. One year after surgery, the patient could walk without assistance and sustain full weight-bearing (Fig. 4b).