Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 10 , ISSUE 3 ( July-September, 2023 ) > List of Articles


Operative Technique: Proximal Femur Allograft Reconstruction and Subtalar Fusion after Total Calcanectomy for a Large Giant Cell Tumor of the Calcaneus

Israel C Manuel, Ilian Dominiq D Eusebio, Emilleo A Dacanay, Bernardino B Alpuerto II

Keywords : Calcanectomy, Case report, Giant cell tumor, Marginal excision, Proximal femur bone allograft, Reconstruction

Citation Information : Manuel IC, Eusebio ID, Dacanay EA, Alpuerto II BB. Operative Technique: Proximal Femur Allograft Reconstruction and Subtalar Fusion after Total Calcanectomy for a Large Giant Cell Tumor of the Calcaneus. J Foot Ankle Surg Asia-Pacific 2023; 10 (3):145-150.

DOI: 10.5005/jp-journals-10040-1286

License: CC BY-NC 4.0

Published Online: 07-07-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Giant cell tumor (GCT) of the feet is rare and occurs in less than 1% of all GCTs of the extremities. Some may have a secondary formation of an aneurysmal bone cyst (ABC). Diagnostics may include radiographs and magnetic resonance imaging (MRI) and treatment varies depending on its classification. Preferably, limb salvage is the treatment of choice. Presentation of Case: We present a 21-year-old male with a large mass in the right heel with pain and difficulty ambulating. The mass involves clinically the whole of calcaneus and is hard, non-tender, non-erythematous, and non-movable. Radiographs show a well-defined osteolytic lesion with a sclerotic rim and neocorticalization. MRI shows fluid-fluid levels. A core needle biopsy was done revealing GCT with secondary ABC. Neoadjuvant therapy using denosumab was given. The patient underwent a marginal excision via total calcanectomy, with reconstruction and subtalar joint arthrodesis using proximal femur allograft secured with 4mm cancellous screws and Achilles tendon V-Y lengthening and reattachment to the allograft via single row suture anchor fixation. At 5 months follow-up, the patient had an excellent clinical appearance with a fused subtalar joint and stable calcaneocuboid joint. Discussion: Intralesional curettage is still the mainstay of treatment when feasible. However, large aggressive lesions may need marginal or wide excision and reconstruction, and in rare cases maybe amputation. We decided to do salvage surgery for the patient and restore as much function as we can. We used the proximal femur allograft as its size and shape are almost the same as with the contralateral calcaneus. Conclusion: Limb salvage surgery, via total calcanectomy and reconstruction using a proximal femur bone allograft, is one good option in treating GTC involving the whole calcaneus. Its main advantage is that the proximal femoral allograft could be fashioned and contoured to be similar in shape and dimensions to the native calcaneus.

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