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Background: Plantar heel pain is a common clinical condition in orthopedic practice, affecting approximately 10% of the population. It has several etiologies, including plantar fasciitis and calcaneal spur. However, assessment of the relationship between plantar fasciitis and calcaneal spur has produced divergent results. Herein, we aimed to assess the outcomes in patients undergoing calcaneal spur resection and its association with plantar fasciitis. Methods: Twenty-five patients with heel pain who were treated conservatively for at least 12 months between November 2022 and October 2023 were included in the study. The American Orthopaedic Foot and Ankle Score (AOFAS) and Visual analogue scale (VAS) for pain, Roles and Maudsley score were calculated preoperatively and postoperatively, which were then compared. Results: A calcaneal spur was a potential pathological factor contributing to plantar fasciitis. The AOFAS, VAS, and Roles and Maudsley scores significantly improved postoperatively. Furthermore, there was no recurrence of calcaneal spurs. CONCLUSION: Surgical excision of calcaneal spurs appears to offer definitive pain relief and is highly effective in managing cases of refractory plantar fasciitis. [ABSTRACT FROM AUTHOR]

Autografts, allografts, bone graft substitutes, and bone replacement materials have been utilized in isolation or in combination to fill bony defects and enhance fracture healing or arthrodesis in all subspecialties of orthopedics. Although there is a robust literature on the effect of bone grafts on managing large bone defects in long bones and arthrodesis, little has been published on the management of calcaneal bony defects. In this review, we aim to discuss the various options for calcaneal bony defects and the current clinical evidence behind each graft option.

A total of 35 patients with 36 Sanders type 2 and 3 calcaneal fractures were treated with open reduction and internal fixation using the sinus tarsi approach. Wires, screws, plates, and combinations of these were used for the fixation of fractures. The patients were followed for 10-44 months and evaluated for radiological and clinical outcomes. Bohler angle was corrected from a preoperative mean of 0.68 degrees (range: 34.7-23.4 degrees) to postoperative mean of 23.5 degrees (range: 16-40 degrees). Gissane angle was corrected from a preoperative mean of 94.7 degrees (range: 41.8-123.8 degrees) to 110 degrees postoperatively (range: 87.7-135.8 degrees). Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scoring. The score, at last follow-up was 62-90 with an average of 82. We conclude that the sinus tarsi approach can be used for earlier intervention and permits adequate access for satisfactory reduction of Sanders type 2 and 3 calcaneal fractures and optimum implant placement. The approach is associated with a low incidence of soft tissue complications.

Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021–2022. The mean patient age was 47 years (range 25–67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patients' return to their earlier, pre-injury level of physical activity. [ABSTRACT FROM AUTHOR]

Compound Gustilo-type III intra-articular calcaneus fractures are challenging to treat. Anatomical reduction of the subtalar joint increases the chances of a better functional outcome and is traditionally achieved by an open reduction and plating. Conversely, ORIF is associated with a high risk of infection and even amputation. In our case study, we present the treatment of a Gustilo-type III intra-articular calcaneus fracture with a circular external fixator and a temporary antibiotic cement spacer for fracture reduction and stabilization. Active bio-glass was implanted to fill bone loss and to prevent infection. A closing-wedge calcaneal tuberosity osteotomy was used to facilitate wound closure. We paid special attention to reducing the posterior facet. The patient returned to work and full ambulation five months post-injury.

Objective:To compare the radiological parameters of the normal population with the patients with Haglund’s syndrome (HS) and to seek a correlation between pain scores and radiological parameters in patients with HS.Methods:Thirty-one patients surgically treated for HS (Haglund group) and 36 healthy subjects free of hindfoot pathology seen in consultation for any other foot pathologies (control group) were included in the study. Demographic data of the patients were acquired, and radiological measurements such as; Fowler Philip Angle (FPA), lateral talus-first metatarsal angle (LTFMA), and Calcaneal pitch angle (CPA) were recorded. The visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) scores of the patients in the Haglund group were assessed.Results:Mean CPA, FPA, and LTFMA in the Haglund group were 23.88±4.6, 58.16±5.7, and 4.92±1.88, respectively, and the same recordings in the control group were 21.16±4.81, 59.1±4.3, and 4.25±2.57, respectively. CPA differences between Haglund and control groups were statistically significant (p=0.021). The average values of the VAS and AOFAS scores of the patients in the Haglund group were 8.45±1.06 and 47.4±7.58, respectively. There was no correlation between the scores and the radiological measurements of patients in the Haglund group.Conclusion:Radiological assessments are widely debated. Many studies support our results that measurements defined for the morphology of calcaneus are not associated with the Haglund’s disease severity. Increase in the CPA is found to be related to HS. This may be explained by the extension of the calcaneus to irritate the Achilles tendon and cause heel pain.

Introduction. Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, whose management is among controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results. Case outline. We present a case of a 54-year-old male patient with a severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture blisters, the patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period was uneventful. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial weight bearing with a gradual increase of weight-bearing to full over the next five weeks, after which walking aids were completely phased out. Three years after surgery, the patient has no symptoms and has a close-to-normal gait. Conclusion. Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery.

Abstract:: Objective: To introduce the application of “Hand as Foot” teaching method in calcaneal skeletal traction nursing.

Calcaneal osteomyelitis with pseudarthrosis after calcaneal fracture is rare, and its treatment is challenging. We describe the use of a free fibular osteocutaneous flap to treat a 52-year-old man who presented with calcaneal osteomyelitis and pseudarthrosis after an operation for a closed comminuted fracture. The patient was previously treated with multiple surgeries and antibiotics for 8 months, but he was not cured. We performed radical osteomyelitis bone debridement and reconstruction with a free fibular osteocutaneous flap and autotrabecular bone grafting from the iliac crest. The skin flap survived, and rehabilitation was initiated early. At 2 years postoperatively, his pain and ambulatory function had markedly improved, and he could walk without problems in daily life. Free fibular osteocutaneous flap and autogenous cancellous bone grafting are considered practical options for the treatment of calcaneal osteomyelitis with pseudarthrosis.

Background: Medial displacement calcaneal osteotomy (MDCO) is routinely used in hindfoot valgus realignment. Minimally invasive surgery (MIS) calcaneal osteotomies have been reported to be as safe and effective compared to open techniques. The aim of this cadaveric study was to compare the amount of medial tuberosity displacement obtained with fine-cut saw-based MIS vs open MDCO techniques. Methods: Eight matched cadaveric specimens had one side randomly assigned to either open or MIS MDCO. The contralateral limb was then assigned to the alternative osteotomy. The amount of medial displacement provided by the osteotomy was measured manually using a flexible metric ruler and radiographically on standardized axial calcaneal radiographs. Results: Manual measurements showed that a mean displacement of the MIS osteotomy was 7.9 mm compared with 8.7 mm for the open technique ( P = .36). Radiograph measurement showed a mean displacement of the MIS osteotomy was 7.1 mm compared with 7.4 mm for the open technique ( P = .83). No significant difference was found on manual and radiographic measurement of medial displacement between MIS and open MDCO. Conclusion: In a cadaveric model, we found similar magnitude of calcaneal tuberosity displacement using fine-cut saw-based MIS and open techniques for medial displacement calcaneal osteotomies. Level of Evidence: Level V, cadaveric study.

The best treatment for displaced, intra-articular fractures of the calcaneus remains controversial and it is generally agreed, that there is no single method that is suitable for all patients.

Background: The calcaneus bone (heel bone) has angles called the Bohler's angle (BA) and the Gissane angle (GA). Estimation of the normal values of these angles can help in their surgical reduction and in restoring the function of the bone in calcaneal fractures. Aim: Our aim is to evaluate the normal limits of BA and GA from lateral view radiographs of the foot of patients presenting to a tertiary care center and also assess the distribution of these parameters with respect to age, sex, and side of the body and also compare them with literature. Methods: A retrospective study was done on 100 randomly selected patients with intact calcaneus bone attending the Department of Orthopedics of our Tertiary Care Hospital between January 2020 and March 2020. Lateral plain radiographs of both feet are obtained and the angles are calculated by two observers using a goniometer and pencil. Mean BA and GA were calculated and their relationship with age, sex, and side of the body were assessed. The SPSS (Statistical Package for Social Sciences. IBM corp, Armonk, NY, USA) software was used. Unpaired t-test for correlation between the mean of angles with gender and with side of the body and one-way ANOVA test was done for correlation between the mean of angles with age. Results: The mean value of BA in our study was 30.03° ±5.09° (range: 20.2°–42.3°) and mean GA was 123.57° ±7.53° (range: 101.5°–135.3°). No statistically significant variations were found for sex (BA: P = 0.2108; GA: P = 0.2172), age groups (BA: P = 0.6003; GA: P = 0.2275), and side of body (BA: P = 0.1819; GA: P = 0.0602). Conclusion: Variations of statistical significance were present between the results of our study with that of other studies in the past. The values obtained from our study can be used as a reference standard for use by orthopedic surgeons in the treatment of calcaneal fractures for Chennai population.