• 1

    Park-Lee E, Caffrey C: Pressure ulcers among nursing home residents: United States, 2004.NCHS Data Brief 14::1. ,2009. .

  • 2

    Smith DM: Pressure ulcers in the nursing home.Ann Intern Med 123::433. ,1995. .

  • 3

    National Pressure Ulcer Advisory Panel: Pressure ulcer prevalence, cost and risk assessment: consensus development conference statement.Decubitus 2::24. ,1989. .

    • Search Google Scholar
    • Export Citation
  • 4

    Fox P, Richardson J, McInnes B, et al: Effectiveness of a bed positioning program for treating older adults with knee contractures who are institutionalized.Phys Ther 80::363. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Mollinger LA, Steffen TM: Knee flexion contractures in institutionalized elderly: prevalence, severity, stability, and related variables.Phys Ther 73::437. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Gaenslen F: Split-heel approach in osteomyelitis of the os calcis.J Bone Joint Surg 13::759. ,1931. .

  • 7

    Randall DB, Phillips J, Ianiro G: Partial calcanectomy for the treatment of recalcitrant heel ulcerations.JAPMA 95::335. ,2005. .

  • 8

    Crandall RC, Wagner FW Jr: Partial and total calcanectomy: a review of thirty-one cases over a ten-year period.J Bone Joint Surg Am 63::152. ,1981. .

  • 9

    Smith DG, Stuck RM, Ketner L, et al: Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis: an amputation of the back of the foot.J Bone Joint Surg Am 74::571. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Lehmann S, Murphy R, Hodor L: Partial calcanectomy in the treatment of chronic heel ulceration.JAPMA 91::369. ,2001. .

Surgical Treatment of Pressure Ulcers of the Heel in Skilled Nursing Facilities

A 12-Year Retrospective Study of 57 Patients

Paul Y. Han Department of Diabetes, Endocrinology and Metabolism, Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA.

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Ruben Ezquerro Department of Surgery, Coastal Communities Hospital, Santa Ana, CA.

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Background: Chronic nonhealing pressure ulcers of the heel in nursing homes are frequent occurrences among bedridden patients with lower-extremity contractures of varying degrees of severity. Conservative local wound care for these patients can be time consuming, ineffective, costly, and may only delay an eventual major leg amputation. This study evaluates the efficacy of limb salvage surgical procedures, partial calcanectomy, total calcanectomy, and excision of the entire calcaneus and talus, for heel ulcers.

Methods: We performed a retrospective review of 57 nursing home residents who had chronic infected nonhealing pressure ulcers of the heel that we had treated over 12 years. Forty-three patients underwent partial calcanectomy, nine underwent total calcanectomy, and five underwent excision of the entire calcaneus and talus. Average postoperative follow-up was 15 months. Also included in this study are representative surgical cases.

Results: Forty-three patients completed follow-up. Complete healing occurred in 25 patients (58%). Failure to resolve the heel ulcer owing to persistent infection, or recurrence was seen in 18 patients (42%) who eventually had a below-the-knee or above-the-knee amputation. All of the patients with heel pressure ulcers were found to have lower-extremity contractures.

Conclusions: In the nonambulatory contracted patient with a heel ulcer, partial or total calcanectomy or excision of the entire calcaneus and talus offer a viable alternative not only for resolution of infection but also for prevention of limb loss. An aggressive plan must also be instituted to address the lower-extremity contractures in order to prevent recurrence. (J Am Podiatr Med Assoc 101(2): 167–175, 2011)

Corresponding author: Paul Y. Han, MS, DPM, Department of Diabetes, Endocrinology and Metabolism, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA 91010-3000. (E-mail: phan@coh.org)