Ambulatory midfoot amputees who subsequently underwent ipsilateral partial calcanectomy for heel osteomyelitis demonstrated maintained ambulation and acceptable residual limb survivorship, suggesting the combined anterior and posterior interventions do not result in prohibitive additive dysfunction.
A cohort of 9 ambulatory midfoot amputees (10 feet) who developed heel osteomyelitis were treated with ipsilateral partial calcanectomy.
Midfoot amputations and partial calcanectomies are each independently documented to cause global biomechanical disruption of the diabetic foot.
Ambulatory midfoot amputees who underwent ipsilateral partial calcanectomy maintained ambulation following the combined interventions.
The residual pedal construct demonstrated acceptable survivorship in ambulatory midfoot amputees who underwent subsequent partial calcanectomy.
This research suggests that patients with diabetes who have already had a partial foot amputation (through the midfoot) and later develop a bone infection in their heel can successfully undergo a second limb-saving surgery — a partial heel bone removal — without losing their ability to walk or losing the remaining foot at unacceptably high rates. The study looked back at 9 patients (10 feet) who went through both of these procedures and found that the combination, while affecting both the front and back of the foot, did not appear to cause compounding problems severe enough to result in major limb loss or loss of walking ability. This matters because doctors have long known that each of these surgeries individually disrupts the normal mechanics of the foot in people with diabetes, making the remaining foot more vulnerable to future problems. The concern with performing both procedures on the same foot was that the combined effect might be too damaging — essentially leaving patients worse off than if a higher-level amputation had been performed initially. This small retrospective study suggests that this 'bidirectional' approach to limb salvage may still be a reasonable option worth considering, potentially sparing patients from above-ankle amputation. It is important to note that this was a small study of only 9 patients, and the findings should be interpreted cautiously. Larger studies would be needed to more definitively establish the safety and effectiveness of this combined surgical approach. The study does not provide specific survival rates, follow-up durations, or statistical analyses in the abstract, so the strength of the evidence remains limited.
Verdin C, Cates N, Shan H, Evans K, Attinger C, Steinberg J, et al.. (2026). Bidirectional Limb Salvage and Its Impact on Residual Limb Survivorship: Is a Partial Calcanectomy in Ambulatory Midfoot Amputees Worthwhile?. Journal of the American Podiatric Medical Association. https://doi.org/10.3390/japma116040056