11/10/2023
Today's case is a revision case where the patient had previously undergone a resection of a painful Haglund's deformity from the back of her left heel with detachment and reattachment of the left Achilles tendon. The patient had difficulty with healing her incision due to medical comorbidities and history of smoking.
When the patient presented to me for a second opinion, she was noted to have two draining sinuses with significant osteomyelitis involving her posterior calcaneus. Drainage was noted to have a blue/green hue, consistent with a chronic pseudomonal infection. Her previous surgeon had recommended a below knee amputation after reviewing her MRI results.
Our initial strategy was a two step approach with immediate initiation of 8 weeks of IV antiobiotics followed by definitive surgical intervention. Upon further review, the plan was for full removal of the previously used bone anchors, debridement of the devitalized calcaneal bone, and filling of the void with antibiotic impregnated bone cement. Ironically, several days prior to her planned surgical revision, one of the anchors was noted to be protruding from the sinus and was actually explanted and removed in office, as pictured.
Included are the preoperative photos of the case and the intraoperative photos with x-rays showing the large bone void and cement spacer used to fill the void.
The patient is now approximately 1.5 years status post and doing very well at this time with full resolution of her infection and significant improvement of pain.
