Indications:
(1) severe ischemia to the forefoot not suitable for a forefoot or midfoot amputation
(2) severe trauma to the forefoot
(3) severe infection to the forefoot
Patient selection:
(1) a palpable posterior tibial pulse (or positive Doppler exam) prior to the operation
(2) ankle-brachial index (ABI) > 0.5
(3) transcutaneous partial pressure of oxygen between 20 and 30 mm Hg
(4) adequate nutrition (serum albumin > 2.5 g/dL)
Potential complications:
(1) instability of the calcaneal flap
(2) dissection of the calcaneum from the underlying flap can result in devascularization of the flap
(3) excision of the calcaneum leads to a shorter stump and a limb length discrepancy
(4) surgical site infection
(5) failure to heal
