Research Article| Volume 50, ISSUE 3, P796-803, March 2019

Calcaneal lengthening for partial traumatic loss of the calcaneus

Published:January 14, 2019DOI:



      The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed.


      From January 2013 to May 2016, calcaneal lengthening was performed in 15 patients who sustained a partial traumatic loss of the tuberosity portion of calcaneus. There were 13 men and 2 women with an average age of 36 years (range, 19–53 years). Combined Achilles tendon rupture was noted in 7 patients, and the tendon was reinserted to the calcaneus before calcaneal lengthening. Calcaneal lengthening was performed using an Ilizarov frame. Clinical outcome was assessed based on the American Orthopedic Foot and Ankle score.


      The mean loss of calcaneus was 27% (range, 19%–35%). Calcaneal lengthening (mean total time is157 days; range, 111–226 days) included three periods, i.e., latency (mean 7 days; range, 7–9 days), distraction (mean 43 days; range, 32–57 days), and consolidation (mean 108 days; range, 84–162 days). The mean amount of lengthening was 28% (range, 19%–38%). The mean follow-up duration was 25 months (range, 24–27 months). Based on the American Orthopaedic Foot and Ankle, there were 8 excellent, 6 good, and 1 fair result.


      For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.


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        • Telfer S.
        • Woodburn J.
        • Turner D.E.
        Measurement of functional heel pad behaviour in-shoe during gait using orthotic embedded ultrasonography.
        Gait Posture. 2014; 39: 328-332
        • Lu S.
        • Chai Y.
        • Wang C.
        • Wen G.
        Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.
        J Reconstr Microsurg. 2014; 30: 83-90
        • Oliver N.G.
        • Steinberg J.S.
        • Powers K.
        • Evans K.K.
        • Kim P.J.
        • Attinger C.E.
        Lower extremity function following partial calcanectomy in high-risk limb salvage patients.
        J Diabetes Res. 2015; 2015432164
        • Evans D.
        Calcaneo-valgus deformity.
        J Bone Joint Surg Br. 1975; 57: 270-278
        • Mosca V.S.
        Calcaneal lengthening for valgus deformity of the hindfoot. Results in children who had severe, symptomatic flatfoot and skewfoot.
        J Bone Joint Surg Am. 1995; 77: 500-512
        • Müller S.A.
        • Barg A.
        • Vavken P.
        • Valderrabano V.
        • Müller A.M.
        Autograft versus sterilized allograft for lateral calcaneal lengthening osteotomies: Comparison of 50 patients.
        Bull Sch Med Univ Md. 2016; 95: e4343
        • Lykoudis E.G.
        • Gantsos A.
        • Dimou A.O.
        Complex calcaneal defect reconstruction with osteotomized free fibula-flexor hallucis longus osteomuscular flap.
        Microsurgery. 2013; 33: 63-68
        • Stockarová D.
        • Pilnácek J.
        • Rubín J.
        • Kolarík M.
        Musculocutaneous flaps for the treatment of chronic osteomyelitis of the heel.
        Acta Chir Plast. 1991; 33: 12-21
        • Imanishi J.
        • Choong P.F.
        Three-dimensional printed calcaneal prosthesis following total calcanectomy.
        Int J Surg Case Rep. 2015; 10: 83-87
        • Gustilo R.B.
        • Anderson J.T.
        Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.
        J Bone Joint Surg Am. 1976; 58: 453-458
        • Gustilo R.B.
        • Mendoza R.M.
        • Williams D.N.
        Problems in the management of type III (severe) open fractures: a new classification of type III open fractures.
        J Trauma. 1984; 24: 742-746
        • Rüedi T.P.
        • Buckley R.E.
        • Moran C.G.
        AO principles of fracture management.
        2nd ed. Georg Thieme Verlag, Stuttgart New York2007: 164-186
        • Sanders R.
        • Fortin P.
        • DiPasquale T.
        • Walling A.
        Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification.
        Clin Orthop Relat Res. 1993; 290: 87-95
        • Essex-Lopresti P.
        The mechanism, reduction technique, and results in fractures of the os calcis, 1951-52.
        Clin Orthop Relat Res. 1993; 290: 3-16
        • Brunner A.
        • Müller J.
        • Regazzoni P.
        • Babst R.
        Open reduction and internal fixation of type C2-C4 fractures of the calcaneus with a triple-plate technique.
        J Foot Ankle Surg. 2012; 51: 299-307
        • Khoshhal K.I.
        • Ibrahim A.F.
        • Al-Nakshabandi N.A.
        • Zamzam M.M.
        • Al-Boukai A.A.
        • Zamzami M.M.
        Böhler’s and Gissane’s angles of the calcaneus in the Saudi population.
        Saudi Med J. 2004; 25: 1967-1970
        • Checketts R.G.
        • MacEachern A.G.
        • Otterburn M.
        Pin track infection and principles of pin site care.
        in: Bastiani G.A. Apley G. Goldberg A. Orthofix external fixation in trauma and orthopaedics. Springer, London2000: 97
        • Reilingh M.L.
        • Beimers L.
        • Tuijthof G.J.
        • Stufkens S.A.
        • Maas M.
        • van Dijk C.N.
        Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view.
        Skeletal Radiol. 2010; 39: 1103-1108
        • Dwyer J.T.
        • Larive B.
        • Leung J.
        • et al.
        Are nutritional status indicators associated with mortality in the Hemodialysis (HEMO) Study?.
        Kidney Int. 2005; 68: 1766-1776
        • Aust M.C.
        • Knobloch K.
        • Reimers K.
        • Redeker J.
        • Ipaktchi R.
        • Altintas M.A.
        • et al.
        Percutaneous collagen induction therapy: an alternative treatment for burn scars.
        Burns. 2010; 36: 836-843
        • Derogatis L.R.
        Symptom Checklist-90-R: administration, scoring, and procedures manual.
        Pearson, San Antonio1994
        • Schneider W.
        • Jurenitsch S.
        Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system.
        Int Orthop. 2016; 40: 301-306
        • Arnold J.B.
        • Mackintosh S.
        • Jones S.
        • Thewlis D.
        Differences in foot kinematics between young and older adults during walking.
        Gait Posture. 2014; 39: 689-694
        • Baravarian B.
        • Menendez M.M.
        • Weinheimer D.J.
        • Lowery C.
        • Kosanovich R.
        • Vidt L.
        Subtotal calcanectomy for the treatment of large heel ulceration and calcaneal osteomyelitis in the diabetic patient.
        J Foot Ankle Surg. 1999; 38: 194-202
        • Baumhauer J.F.
        • Fraga C.J.
        • Gould J.S.
        • Johnson J.E.
        Total calcanectomy for the treatment of chronic calcaneal osteomyelitis.
        Foot Ankle Int. 1998; 19: 849-855
        • Bollinger M.
        Thordarson DB.PArtial calcanectomy: an alternative to below knee amputation.
        Foot Ankle Int. 2002; 23: 927-932
        • Boffeli T.J.
        • Collier R.C.
        Near total calcanectomy with rotational flap closure of large decubitus heel ulcerations complicated by calcaneal osteomyelitis.
        J Foot Ankle Surg. 2013; 52: 107-112
        • Smith D.G.
        • Stuck R.M.
        • Ketner L.
        • Sage R.M.
        • Pinzur M.S.
        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. 1992; 74: 571-576
        • Lehmann S.
        • Murphy R.D.
        • Hodor L.
        Partial calcanectomy in the treatment of chronic heel ulceration.
        J Am Podiatr Med Assoc. 2001; 91: 369-372
        • Su Y.
        • Chen W.
        • Zhang Q.
        • Liu S.
        • Zhang T.
        • Zhang Y.
        Bony destructive injuries of the calcaneus: long-term results of a minimally invasive procedure followed by early functional exercise: a retrospective study.
        BMC Surg. 2014; : 14-19
        • Liu R.
        • Li Z.
        • Jin A.
        Heel reconstruction with parallel fibular osteoseptocutaneous flap.
        Acta Orthop Belg. 2016; 82: 275-279
        • Xu Y.
        • Li X.C.
        • Xu X.Y.
        Calcaneal z lengthening osteotomy combined with subtalar arthroereisis for severe adolescent flexible flatfoot reconstruction.
        Foot Ankle Int. 2016; 37: 1225-1231
        • Doğan A.
        • Albayrak M.
        • Akman Y.E.
        • Zorer G.
        The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot.
        Acta Orthop Traumatol Turc. 2006; 40: 356-366
        • Ahmad Khan R.D.
        • Maqbool M.A.
        • Yasin A.
        Effectiveness of ilizarov frame fixation on functional outcome in aseptic tibial gap non-union.
        J Pak Med Assoc. 2015; 65: S179-S185
        • Van Riet A.
        • Harake R.
        • Stuyck J.
        Partial calcanectomy: a procedure to cherish or to reject?.
        Foot Ankle Surg. 2012; 18: 25-29