A 59-year-old Caucasian male with type 2 diabetes of 7 years' duration and history of multiple foot surgeries for the treatment of infected neuropathic plantar ulcers underwent a successful transmetatarsal amputation of his right foot, 2 years earlier. He had recently been treated for a full-thickness ulcer beneath his 4th metatarsal head. This lesion was unresponsive to conservative care, and an Achilles tendon lengthening procedure was performed. The forefoot ulcer healed quickly following the tendon lengthening: however, the patient went on to rupture his tendon and developed a calcaneus gait. The result of elevated pressure beneath his heel was the development of a chronic full-thickness ulcer, approximately 3.0 x 2.0 cm (Fig. 8.19). Although the patient had adequate distal perfusion, the ulcer failed to heal with conservative therapy;
total-contact casting, local wound care and antibiotics. Osteomyelitis was suspected. Partial calcanectomy, a salvage procedure, was offered to the patient as an alternative to below-knee amputation and he consented to the operation.
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