Tibiocalcaneal fusion with autogenous bone graft and intramedullary nailing

A 74-year-old gendeman, with type 2 diabetes of 17 years' duration, presented for initial consultation to the diabetic foot clinic with the chief complaint of swelling and deformity of his left ankle that developed suddenly and unexpectedly following an ankle sprain 6 months earlier. The patient had previously been treated elsewhere with a walking brace. Physical examination revealed marked deformity of the left ankle, characterized by swelling and displacement of the foot lateral to the leg. Pitting oedema extended up the leg to the level of the knee. There was a shallow ulcer 1.0 cm diameter on the medial malleolus that appeared to be caused by the brace. Skin temperature was elevated over the entire limb. Neurological examination revealed absent deep tendon reflexes at the ankle. Vibratory sensation was diminished below the knee, and absent below the malleoli. Loss of protective sensation was noted, with the patient unable to feel the Semmes-Weinstein 6.10 (90 g) monofilament. Pedal pulses were not palpable due to the swelling of the foot and ankle. Initial conservative management consisted of cast immobilization and non-weightbearing. Despite these efforts,

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