Lateral Plantar Angioplasty and Reverse Sural Flap Reconstruction for Complex Heel Limb Salvage.
This study reports on a complex case in which doctors treated a deep, infected heel wound in a 58-year-old woman with insulin-dependent diabetes. Diabetic foot ulcers are hard to heal when the arteries in the leg are narrowed or blocked, and heel wounds are especially difficult because that area bears the body's weight and has little soft tissue to spare. The patient had a chronic infected ulcer on the sole of her heel with exposed heel bone (calcaneus) and suspected bone infection (osteomyelitis). Imaging showed blood was still reaching the foot through one artery (the dorsalis pedis), but the main artery to the back of the leg and the arteries to the sole of the foot were chronically blocked. Because the planned reconstructive surgery — a reverse sural flap, which borrows skin and tissue from the calf to cover the heel — needs strong blood flow, the surgeons first performed a lateral plantar angioplasty to open a blocked artery in the sole of the foot with a balloon. This case report suggests that carefully restoring blood flow even when some flow is still present may help support complex heel reconstruction and avoid amputation. However, this is a single patient report, so it does not prove the approach works for everyone; larger studies are needed, and outcomes may differ in other patients.
Key takeaways
- Heel ulcers are especially challenging because the heel bears weight and has little cushioning tissue to cover exposed bone after surgery.
- Doctors used balloon angioplasty to open a blocked sole artery before a reverse sural flap to cover the heel.
- Revascularization was done even though some in-line flow to the foot was already present, which is less well studied.
- This is a single case report, so it cannot show how often this combined approach succeeds or who benefits most.
- Ask your doctor whether blood flow to the foot has been fully evaluated before any flap or amputation decision.
- Ask if a team with vascular and reconstructive specialists can try limb salvage before considering major amputation.
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This content summarizes published medical research for educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making treatment decisions.
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Editor's note
Think of the arteries in your leg like a river system feeding a garden: when one channel silts up, the plants downstream start to wither. In this case, the surgeons first used a tiny balloon to reopen a blocked channel in the sole of the foot, then borrowed healthy tissue from the calf and rotated it down to cover the open heel wound. For someone who has been told their wound will never heal or that amputation is the only answer, this case is genuinely encouraging — it shows that limb salvage can sometimes be achieved with a combined plan rather than going straight to removal of the leg. In China's major specialist diabetic foot centres, both balloon angioplasty and reverse sural flap reconstruction are established, routinely performed techniques, and many centres are experienced in combining them in one coordinated treatment plan. As an overseas patient, the key is to seek a centre where vascular and plastic or reconstructive surgeons work together and can assess your own arteries with imaging before deciding on a strategy.