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CC BY 4.0 · Indian J Plast Surg
DOI: 10.1055/s-0045-1812021
Original Article

Posttraumatic Soft Tissue Defects of the Heel: Comparison of Reconstructive Options and Results

Authors

  • Satyaki Roy 

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Harin Asokan

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Jerry R. John

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Ashu Rastogi

    2   Department of Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Satyaswarup Tripathy 

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Sunil Gaba 

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India

  • Ramesh K. Sharma

    1   Department of Plastic Surgery, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Abstract

Introduction

The heel is difficult to reconstruct if it is avulsed off following accidents. Heelpad avulsion may be suprafascial or subfascial. Reconstructive options include skin grafts and flaps, depending on the involvement of weight-bearing area and exposed bone. We describe a series of patients who underwent heel pad reconstruction.

Materials and Methods

Patients were grouped into two, depending on flap or graft reconstruction. The number of operations, time taken for recovery, complications, revision surgery, sensations, and footwear use were analyzed. Dynamic pedogram analysis was performed to assess heel pressures.

Results

Twenty-one patients were assessed, out of which flap reconstruction was performed in 12. Nineteen patients achieved full weight bearing. Seventeen patients required revision procedures such as flap thinning. The mean time to walk, in the flap group was 14.3 weeks (range: 10–20 weeks) while that in the graft group was 11.5 weeks (range: 6–16 weeks). There was no difference in the reinnervation when comparing presence of light touch (p = 0.49) and pain (p = 0.37) between the two groups. On pedogram analysis, the mean peak pressures in the graft group were significantly less when compared with normal foot (p = 0.017). The mean peak pressures were comparable in both involved and uninvolved feet, among patients who underwent flap reconstruction.

Conclusion

Skin grafts demonstrated good stability even in the absence of customized footwear. A flap procedure can be avoided for suprafascial avulsions. The level of protective sensation achieved by spontaneous reinnervation seems to be sufficient for maintaining a functional well-healed foot.

Keywords

heel pad avulsion - skin grafts - fasciocutaneous flaps - weight-bearing - reconstructive surgery - dynamic pedogram analysis - protective sensation - suprafascial versus subfascial - revision procedures - foot pressure distribution

Ethical Approval

Ethical approval was provided by the Institutional ethical committee prior to commencement of the study.


Patients' Consent

The study was conducted after taking written informed consent to participate from the participants.




Publication History

Article published online:
10 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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