["Calcaneogenesis" with secondary Achilles tendon-bone allograft for repair of the loss of hindfoot function : A 12-year case report].

Abstract

Background: Calcanectomy and Achilles tendon resection are very hard to repair.

Objective: Ilizarov's "calcaneogenesis" is possible with ankle joint preservation. Even after 3.5 years of functio laesa of the triceps surae muscle it can be rebuilt.

Material and methods: A 25-year-old motorcyclist suffered a 3rd degree open calcaneal dislocation fracture (type 5). Osteitis and necrosis required calcanectomy, resection of the Achilles tendon and a latissimus dorsi muscle transfer. A talus corpus osteotomy with Ilizarov distraction created in the 1st step a "neo-calcaneus". In a delayed 2nd step a fresh-frozen Achilles tendon-bone block allograft was transplanted to regain active plantar flexion.

Results: The initial AOFAS score of 35 points was significantly improved to 70 points 12 years after step 1. After both operations the patient could walk without an orthosis and regained 88% of normal plantar flexion strength. Quantitative measure of health outcome according to EQ-5D-5L was marked by the patient with 80 out of 100 points.

Discussion: "Calcaneogenesis" with preservation of the ankle joint is possible and innovative. Despite 3.5 years of disconnection of the triceps surae muscle, an Achilles tendon-bone block allograft could restore 88% of the push-off force even attached to a neo-calcaneus that is 1/3 smaller than normal, which is also new.