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4 Cases of calcaneus Osteomyelitis caused by "diagnostical heel punction" are demonstrated. More attention should be paid to this complication which is not enough mentioned in literature.
An 11-year-old girl with splastic quadriplegia, and immobilization atrophy developed a stress fracture of the calcaneus, are rare cause of heel pain in children. There was complete remission of symptoms with healing of the fracture.
In fractures of the calcaneus the fundamental importance of complete restoration of the architectural structure of the bone is stressed. To this end, the technique of internal fixation calls for a special device. Three different types of plate are described and the indications for each discussed.
Heel pad puncture, a well-established procedure for obtaining hematologic samples from infants, may be complicated by acute osteomyelitis of the calcaneus. One such case is presented which involved a 3½-month-old female. Physicians are cautioned that calcaneal osteomyelitis should be suspected if soft tissue swelling and erythema are present around the heel area.
Chronic leg ulcers may expose and destroy the tendo calcaneus, unless it can be covered soon. Current methods of management do not present a ready method. It is suggested that local muscle transpostion, with skin grafting over the muscle, is an effective form of treatment. An illustrative case is reported, and our clinical experience is presented.
Certain post-traumatic defects of the lower extremity present difficult problems in therapy and current methods of management do not offer satisfactory solutions. One such defect is an ulcerative lesion of the lower limb eroding the tibia and forming a chronic, rigid-walled cavity. We describe an operation in which the bone cavity is filled by viable tissue which acts as a bed for a skin graft. In chronic stasis ulcers it has been established that the tendo calcaneus will accept a skin graft, provided the paratenon is left undisturbred.
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From our findings it appears that no one method of treatment is infallible and that functional and anatomical restitutio ad integrum of the fractured heel cannot be obtained. Each method has its advantages and disadvantages and these are not only inherent in the method itself, but also depend on how it is applied. The treatment must be chosen according to the lesion and cannot be standardised because of the variable and complex nature of these fractures. Other factors to be considered are whether it is bilateral, whether there are multiple injuries, and the general condition of the patient etc. In fractures with depressions of the mixed horizontal type the Stulz method of treatment seems to be the best.
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In the investigation 183 first metatarsi and heel bones of ancient and contemporary people have been examined. It has been stated that the first metatarsi in contemporary people exceed in length those of ancient people. The thickness of substantia compacta of the first metatarsus, as well as the thickness of the tuber calcanei and lamina plantaris of the heel bones was more pronounced in ancient people than in contemporary people. Spongious trabeculae in ancient men were greater in number and thickness.
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