Overview

Calcaneus deformity of the foot is common in patients with myelodysplasia, mainly due to muscle imbalance. This deformity, especially in ambulatory patients, can result in gait problems and development of pressure sores, which can be complicated by calcaneal osteomyelitis.

Material and methods

This retrospective cross-sectional study included 12 patients (18 feet), with calcaneus deformity due to myelomeningocele, and presented with penetrating heel ulcers complicated by calcaneal osteomyelitis. The mean age of the included cases was 11 years. The ulcers were unilateral in six patients and bilateral in six. Sensation was absent on the plantar aspect of the foot in all cases. The treatment was done in two stages; The first stage was eradication of infection and obtaining good soft tissue coverage, and the second stage was obtaining motor balance to achieve a more plantigrade and braceable foot.

Results

The average follow-up period was 19.2 months. In the final follow-up, twelve feet were graded as good, five as fair and one as poor according to Legaspi grading system.

Conclusion

The combination of partial calcanectomy and subsequent transfer of tibialis anterior tendon, to improve the foot position and gait, can efficiently prevent ulcer recurrence in myelomeningocele patients with calcaneal deformity.

Level of clinical evidence: 4

Retrospective case series study.

中文翻译：

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复发性足跟溃疡合并脊髓脊膜膨出跟骨骨髓炎：部分跟骨切除术和胫骨前肌腱后移治疗

概述

足部跟骨畸形在骨髓增生异常患者中很常见，主要是由于肌肉失衡所致。这种畸形，特别是在门诊患者中，会导致步态问题和压疮的发展，并可能并发跟骨骨髓炎。

材料与方法

这项回顾性横断面研究包括 12 名患者（18 英尺），他们因脊髓脊膜膨出导致跟骨畸形，并出现穿透性足跟溃疡并发跟骨骨髓炎。纳入病例的平均年龄为 11 岁。6 例患者的溃疡是单侧的，6 例是双侧的。所有病例足底面均无感觉。治疗分两个阶段进行；第一阶段是根除感染并获得良好的软组织覆盖，第二阶段是获得运动平衡以实现更加顺行和可支撑的脚。

结果

平均随访期为 19.2 个月。在最后的跟进中，根据 Legaspi 分级系统，12 英尺被评为好，5 英尺为一般，1 英尺为差。

结论

结合部分跟骨切除术和随后的胫骨前肌腱转移，改善足部位置和步态，可以有效预防跟骨畸形脊髓脊膜膨出患者的溃疡复发。

临床证据等级：4

回顾性病例系列研究。