Abstract
Background: Total calcanectomy has been proposed as a definitive limb-salvage strategy in non-ambulatory patients with heel ulceration and calcaneal osteomyelitis, potentially facilitating primary wound closure and reducing complications associated with persistent bony prominence. Methods: A retrospective review of non-ambulatory patients undergoing partial or total calcanectomy for calcaneal osteomyelitis at a single limb salvage center between 2011 and 2021 was performed. Demographic, perioperative, and postoperative data were analyzed. Primary outcomes included wound complications, limb salvage, and subsequent proximal amputation. Statistical significance was defined as p ≤ 0.05. Results: Sixty-two patients underwent 63 calcanectomy procedures (48 partial, 15 total). Baseline demographic, vascular, laboratory, and microbiologic characteristics were comparable between groups. No statistically significant differences were observed in closure strategy, postoperative complications, length of stay, or limb salvage rates, although a non-significant trend toward higher below-knee amputation rates was observed following total calcanectomy. Conclusions: In medically complex, non-ambulatory patients, partial and total calcanectomy demonstrated similar rates across most measured outcomes, with a nonsignificant trend toward higher below-knee amputation after total calcanectomy that warrants further investigation with larger cohorts. These findings suggest that surgical decision-making should prioritize infection control and durable wound closure rather than preservation of calcaneal structure in this high-risk population.