Journal of Foot and Ankle Surgery (Asia Pacific)

Register      Login

VOLUME 9 , ISSUE 2 ( April-June, 2022 ) > List of Articles

Review Paper

Surgical Options for Calcaneal Bony Defects: Current Clinical Evidence

Jong M Lee, Richard Buckley, Andrew Clark, Colin Drury, Christopher Del Balso, Amir Khoshbin, Timothy Daniels, Mansur Halai

Keywords : Best evidence, Bone substitute, Calcaneal fracture

Citation Information : Lee JM, Buckley R, Clark A, Drury C, Del Balso C, Khoshbin A, Daniels T, Halai M. Surgical Options for Calcaneal Bony Defects: Current Clinical Evidence. J Foot Ankle Surg Asia-Pacific 2022; 9 (2):56-60.

DOI: 10.5005/jp-journals-10040-1213

License: CC BY-NC 4.0

Published Online: 01-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Autografts, allografts, bone graft substitutes, and bone replacement materials have been utilized in isolation or in combination to fill bony defects and enhance fracture healing or arthrodesis in all subspecialties of Orthopaedics. Although there is a robust literature on the effect of bone grafts on managing large bone defects in long bones and arthrodesis, little has been published on the management of calcaneal bony defects. In this review, we aim to discuss the various options for calcaneal bony defects and the current clinical evidence behind each graft option.

  1. Keeling JJ, Hsu JR, Shawen SB, et al. Strategies for managing massive defects of the foot in high-energy combat injuries of the lower extremity. Foot Ankle Clin 2010;15(1):139–149. DOI: 10.1016/j.fcl.2009.10.003
  2. Chan CW, Rudins A. Foot biomechanics during walking and running. Mayo Clin Proc 1994;69(5):448–461. DOI: 10.1016/s0025-6196(12)61642-5
  3. Nauth A, McKee MD, Einhorn TA, et al. Managing bone defects. J Orthop Trauma 2011;25(8):462–466. DOI: 10.1097/BOT.0b013e318224caf0
  4. Scranton PE, Jr. Use of bone graft substitutes in lower extremity reconstructive surgery. Foot Ankle Int 2002;23(8):689–692. DOI: 10.1177/107110070202300802
  5. Arner JW, Santrock RD. A historical review of common bone graft materials in foot and ankle surgery. Foot Ankle Spec 2014;7(2):143–151. DOI: 10.1177/1938640013516358
  6. Keating JF, Simpson AH, Robinson CM. The management of fractures with bone loss. J Bone Joint Surg Br 2005;87(2):142–150. DOI: 10.1302/0301-620x.87b2.15874
  7. Azi ML, Aprato A, Santi I, et al. Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis. BMC Musculoskelet Disord 2016;17(1):465. DOI: 10.1186/s12891-016-1312-4
  8. Boone DW. Complications of iliac crest graft and bone grafting alternatives in foot and ankle surgery. Foot Ankle Clin 2003;8(1):1–14. DOI: 10.1016/s1083-7515(02)00128-6
  9. Cox G, Jones E, McGonagle D, et al. Reamer-irrigator-aspirator indications and clinical results: a systematic review. Int Orthop 2011;35(7):951–956. DOI: 10.1007/s00264-010-1189-z
  10. Sagi HC, Young ML, Gerstenfeld L, et al. Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crest of the same patient. J Bone Joint Surg Am 2012;94(23):2128–2135. DOI: 10.2106/JBJS.L.00159
  11. Stanec Z, Krivic A, Stanec S, et al. Heel reconstruction with an iliac osteocutaneous free flap: 10-year follow-up. Ann Plast Surg 2004;53(2):174–177. DOI: 10.1097/
  12. Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg 2004;114(6):1457–1466. DOI: 10.1097/01.prs.0000138811.88807.65
  13. Peek A, Giessler GA. Functional total and subtotal heel reconstruction with free composite osteofasciocutaneous groin flaps of the deep circumflex iliac vessels. Ann Plast Surg 2006;56(6):628–634. DOI: 10.1097/
  14. Endo J, Kuniyoshi K, Mochizuki M, et al. Two-staged hindfoot reconstruction with vascularized fibula graft for calcaneal osteomyelitis caused by methicillin-resistant Staphylococcus aureus: a case report. Microsurgery 2013;33(3):232–235. DOI: 10.1002/micr.22070
  15. Bansal R, Halai M, Matthews JL, et al. Partial calcaneus reconstruction using ‘Opportunistic Grafts’: a case report. J Foot Ankle Surg 2021;60(1):199–203. DOI: 10.1053/j.jfas.2020.08.025
  16. Neufeld SK, Uribe J, Myerson MS. Use of structural allograft to compensate for bone loss in arthrodesis of the foot and ankle. Foot Ankle Clin 2002;7(1):1–17. DOI: 10.1016/s1083-7515(01)00002-x
  17. Myerson MS, Neufeld SK, Uribe J. Fresh-frozen structural allografts in the foot and ankle. J Bone Joint Surg Am 2005;87(1):113–120. DOI: 10.2106/JBJS.C.01735
  18. Fitzgibbons TC, Hawks MA, McMullen ST, et al. Bone grafting in surgery about the foot and ankle: indications and techniques. J Am Acad Orthop Surg 2011;19(2):112–120. DOI: 10.5435/00124635-201102000-00006
  19. Wee J, Thevendran G. The role of orthobiologics in foot and ankle surgery: allogenic bone grafts and bone graft substitutes. EFORT Open Rev 2017;2(6):272–280. DOI: 10.1302/2058-5241.2.160044
  20. Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am 2002;84(6):921–929. DOI: 10.2106/00004623-200206000-00005
  21. Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: a review. Bioact Mater 2017;2(4):224–247. DOI: 10.1016/j.bioactmat.2017.05.007
  22. Yeo QY, Kee Kwek EB. Use of a biphasic cement bone substitute in the management of metaphyseal fractures. J Clin Orthop Trauma 2019;10(4):789–791. DOI: 10.1016/j.jcot.2018.08.014
  23. Whisstock C, Volpe A, Ninkovic S, et al. Multidisciplinary approach for the management and treatment of diabetic foot infections with a resorbable, gentamicin-loaded bone graft substitute. J Clin Med 2020;9(11):3586. DOI: 10.3390/jcm9113586
  24. Jariwala SH, Lewis GS, Bushman ZJ, et al. 3D printing of personalized artificial bone scaffolds. 3D Print Addit Manuf 2015;2(2):56–64. DOI: 10.1089/3dp.2015.0001
  25. Imanishi J, Choong PF. Three-dimensional printed calcaneal prosthesis following total calcanectomy. Int J Surg Case Rep 2015;10:83–87. DOI: 10.1016/j.ijscr.2015.02.037
  26. Park JW, Kang HG, Kim JH, et al. New 3-dimensional implant application as an alternative to allograft in limb salvage surgery: a technical note on 10 cases. Acta Orthop 2020;91(4):489–496. DOI: 10.1080/17453674.2020.1788698
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.