A 49-year-old woman with diabetes with a history of a plantar right-foot heel ulcer of 4-month duration initially presented to the SALSA clinics at the University of Arizona College of Medicine, Tucson. She had a history of Charcot changes to her midfoot and rearfoot making the calcaneus prominent to the plantar aspect (Fig ). She had undergone a previous surgical debridement of the ulcer, but it was unable to heal. After presenting to our clinic, she was managed with aggressive offloading, consisting of a CROW boot as well as standard ulcer care. With this combination, the ulcer became very superficial and was on the verge of being healed. She then went on vacation and returned with an increase in ulcer size and depth, probing the calcaneus (Fig ). To address this misadventure, surgical intervention was performed using the hurricane incision approach. The calcaneus was debrided and the incision was closed. Bolster sutures were used to the central aspect of the incision to reduce any potential tension. A Jackson-Pratt drain was placed, and the patient was placed in a posterior splint with strict non–weight-bearing orders. On her first postoperative visit (Fig ), the incision was well approximated with no signs of dehiscence or infection. The sutures were removed at 3 weeks.
A 52-year-old gentleman with diabetes and morbid obesity with a chief complaint of a right heel ulcer of 5-months duration presented to the clinic. The ulcer formed as a result of a burn that he received while walking barefoot outside on a hot wooden deck. He had a history of a total right hip replacement in which nerve damage as a result of the surgery caused a right-foot drop and loss of sensation to the right plantar foot. After months of both surgical and conservative care, his ulcer was superficial but unable to close fully (Fig ). At this point, a partial calcanectomy with hurricane incisional approach was done to obtain ulcer closure. The calcaneus was debrided and the incision was closed (Fig ). At the second postoperative visit, the central aspect of the incision had dehisced, most likely because of pressure or weight bearing as the patient admitted to resting his foot on the ground. However, the wound was still far smaller than preoperatively and responded well to local wound care.