Healing From the Heel : Gaenslen's Approach in Chronic Calcaneal Osteomyelitis-a Surgical Revival

Background: Chronic calcaneal osteomyelitis is a therapeutic challenge due to complex anatomy, poor vascularity, and high load-bearing function. Gaenslen's posterior midline approach offers a direct route for thorough debridement with minimal soft tissue compromise. This study evaluates the clinical efficacy, surgical outcomes, and complications associated with the use of Gaenslen's window in treating chronic calcaneal osteomyelitis. In a prospective study spanning 14 months, 22 patients (aged 18–65) with culture-prov Methods: en chronic calcaneal osteomyelitis underwent surgical debridement using Gaenslen's window. Detailed preoperative planning, intraoperative technique, and postoperative care were standardized. Outcomes evaluated included infection resolution (clinical and biochemical), radiological bone healing, wound healing time, recurrence rate, need for reoperation, and functional status using AOFAS hindfoot score. Results: Ÿ Infection resolution achieved in 90.9% (20/22) patients. Ÿ Average wound healing time was 4.9 weeks. Ÿ Mean AOFAS hindfoot score improved from 41.6 ± 7.4 pre-op to 84.3 ± 5.8 at 6 months. Ÿ Recurrence noted in 2 cases, both managed with repeat debridement. Ÿ Gait restoration and independent ambulation achieved in all except one patient requiring walking aid. Ÿ No major soft tissue or neurovascular complications reported. Conclusion: Gaenslen's approach remains an effective, limb-salvaging, and anatomically favorable method for managing chronic osteomyelitis of the calcaneum. It allows direct access for thorough debridement, localized antibiotic delivery, and functional restoration with minimal morbidity.