PMC9772964_01
A preoperative image of the medial aspect of the right foot displays scars from previous procedures.
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On examination, the patient displayed 20  of dorsiflexion and 5  of plantarflexion with 3/5 muscle strength for both, and poorly healed skin over the hindfoot (Figure 1).
A preoperative lateral weight-bearing radiograph of the right foot demonstrates a partial calcanectomy.
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Preoperative X-ray images suggested post-surgical changes related to his previous subtotal resection of the posterior aspect of the calcaneus to the level of the middle subtalar joint with abnormality of the overlying soft tissues related to scarring (Figure 2).
Intraoperative radiographs display (a) K-wire placement and (b) cannulated screw placement for the subtalar arthrodesis involving the femoral head allograft and remaining calcaneus.
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The screws engaged both the endogenous calcaneus and the allograft (Figure 3).
A 4-week postoperative image of the medial aspect of the right foot which displays soft tissue healing.
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The soft tissue was stable, with a viable flap and split-thickness graft at 4 weeks post-operation (Figure 4).
An 8-week postoperative lateral non-weight-bearing radiograph showing signs of bone healing.
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Radiographs taken at this point showed signs of bone healing (Figure 5).
A 9-month postoperative lateral non-weight-bearing radiograph demonstrating screw loosening.
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At approximately 9 months post-operation, the patient presented to the emergency room for heel pain upon weight-bearing, and subsequent images displayed a loose screw (Figure 6).
Intraoperative radiograph of the hardware replacement: removal of 6.5 mm screw and replacement with an 8.0 mm screw (shown above).
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However, 1 month later, he underwent surgery to remove and replace that screw and DBM injected into the screw tract to promote osteoconduction (Figure 7).
A 15-month standing weight-bearing radiograph displaying subtalar arthrodesis with the presence of osseous bridging across the osseous margins.
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Radiographs taken at 15 months display osseous bridging across the osseous margins (Figure 8).