Gaenslen\'s Split-heel Approach for Management of Chronic Calcaneal Osteomyelitis: A Case Report and Literature Review

Background: Calcaneal osteomyelitis is difficult to treat. Various surgical procedures to manage chronic osteomyelitis of the calcaneus, that is, partial, total calcanectomy, split-heel approach, and vascularized flaps to cover the ulcer, have been employed with variable and often disappointing results. Way back in 1931, Gaenslen reported his split-heal or cloven-heel method approach, with satisfactory healing in all patients and no plastic or secondary operations. In spite of the uniformly good results in all calcaneum osteomyelitis cases shown subsequently, it seems that this is not a popular approach, the literature is sparse, and the most recent publication on this approach and technique was in 2010 by Bhattacharya and Das. This approach and technique has not received much attention as a preferred treatment choice primarily and is usually reserved for patients with resistant or recurrent disease. Our case report and systematic review of this method reveal that it is a safe and effective technique and that it shall be used primarily in all patients of calcaneal osteomyelitis, with or without a plantar ulcer, in children and adults alike. Conclusion: Overall, it seems reasonable to state that it is a safe and very effective technique. Only two recurrences and one reoperation are noted in this entire literature review. It remains a moot point whether this approach and technique shall be routinely indicated in all patients of calcaneal osteomyelitis with or without a plantar ulcer, and further studies may be required. This approach ought to be renamed the Landerer-Gaenslen approach in future references. We are hopeful that we have revisited and revived this useful and safe technique and attempted to rekindle the memory of the fascinating classic paper by author Gaenslen, reviewed and refined the indications through our case report and literature survey. Level of evidence: Level 5.