CASE REPORT


Traumatic Heel Pad Avulsion in a Pediatric Patient



Joseph P. Kelly1, *, Benjamin Catoe1, Mudassar Khan1, David P. Antekeier2
1 Jack Hughston Memorial Hospital Orthopaedic Surgery Residency Program, Phenix City, AL The Hughston Foundation, Inc., Columbus, GA, USA
2 The Hughston Clinic, The Hughston Foundation, Inc., Columbus, GA, USA


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Creative Commons License
© 2021 Kelly et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at The Hughston Foundation, Inc. 6262 Veterans Pkwy. Columbus, Georgia, 31909; Tel: +1 (630) 890-2572;
Fax: (706) 494-3379; E-mail: joseph.kelly.004@gmail.com


Abstract

Introduction:

Heel pad injuries can have devastating and debilitating consequences. All efforts to primarily reapproximate the heel pad should be undertaken. Reconstruction of the heel pad can often require multiple complex surgeries including microvascular flaps and tissue transfers. There is a paucity of successful techniques for primary repair in the literature.

Case Presentation:

In this case report, we describe the successful use of polydioxanone suture with sterile buttons for the repair of the heel pad in a pediatric patient. An 8-year-old male was struck by a vehicle, sustaining a full-thickness heel pad avulsion injury measuring approximately 16-cm in length. The soft tissue was sharply debrided and repaired primarily to the calcaneal periosteum using #1 polydioxanone suture with external suture buttons, and an incisional wound VAC was applied. He was placed into a long-leg bent knee cast and kept non-weight bearing for a total of 6 weeks, at which time the suture and buttons were removed and he was progressed to weight bearing as tolerated in a walking boot. At the 6-month follow-up examination, the heel pad was viable and well-fixed; the patient reported no pain and was not limited in any chosen activities.

Conclusion:

This construct was shown to provide effective fixation while mitigating reported concerns of tissue necrosis caused by suture repair. At 1 year from injury, the patient’s mother noted a slight limp with running but not with walking. He reported no pain at any time, and his Oxford Ankle-Foot Questionnaire for Children score was 58, indicating excellent patient-reported outcome following his procedures.

Key words: Heel pad, Avulsion, Suture, Repair, Pediatric, Polydioxanone, Case report.