Prophylactic Irradiation for the Prevention of Heterotopic Ossification After Foot Amputation: A Case Series.

Background: The formation of heterotopic ossification (HO) is a common complication after transosseous partial foot amputation. Development of HO in weightbearing and/or superficial areas can lead to increased pressures, which increases the likelihood of wound formation and pain. Current treatment modalities for HO of the foot include mechanical off-loading and surgical resection; however, prophylactic measures such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and other medical therapies have been attempted previously with mixed efficacy. Radiation therapy is another prophylactic method that may be used for the prevention of HO in patients after transosseous partial foot amputation.

Methods: The present case series evaluated ten patients who underwent transosseous partial foot amputation for HO resection immediately followed by single low-dose radiation treatment. All of the patients received radiation between 700 and 800 cGy, with 6 MV photons directed at the area of concern within 48 hours of surgery.

Results: Postoperatively, 10% of patients had HO recurrence, 80% remained fully weightbearing, 90% went on to primarily heal their surgical incisions, and 80% had postoperative pain relief; however, 30% went on to below-the-knee amputation due to chronic pain and/or infectious or nonfunctional pathology.

Conclusions: Radiation therapy is a relatively available and safe modality for the prevention of HO that may be used prophylactically in cases of high suspicion of or known HO formation of the foot.