JAAOS - 2026-07-15 - Journal Article
Heel Pad Degloving Injuries: A Case Series.
Lutnick E, LaNicca M, Montero J, Ritter C, Mutty C
Topics
Key Takeaway
In 12 patients with heel pad degloving injuries, 50% developed infections, 20% required below-knee amputation, and 5 of 7 limb-salvage patients had persistent pain at final follow-up.
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Summary
This retrospective case series identified 12 patients with heel pad degloving injuries associated with ipsilateral foot or ankle fractures at a single Level 1 trauma center over 19 years. Of 10 patients with available follow-up, 5 developed infections, 2 underwent BKA, and 7 achieved limb salvage—of whom 3 required flap coverage, 5 had persistent pain, 6 required an assistive device, and 4 had sensory disturbances. The study characterizes injury patterns and outcomes in the absence of any existing consensus management algorithm.
Key Limitation
With only 12 patients over 19 years at a single center, the cohort is too small and heterogeneous to identify any predictors of amputation, infection, or functional outcome.
Original Abstract
INTRODUCTION
Heel pad degloving injuries are rare but serious injuries, with minimal data available regarding optimal management. In this study, a series of patients treated for heel pad degloving injuries in association with ipsilateral lower leg and foot fractures is described.
METHODS
Records were retrospectively reviewed for patients aged 18 years and older treated for heel pad degloving injuries associated with ipsilateral foot or ankle fractures at one American College of Surgeons Level 1 center between January 1, 2005, and January 1, 2024, screened using International Classification of Diseases, 10th Revision codes related to any open fractures of the foot or ankle. Patient demographics, injury patterns, treatment data, and outcomes were recorded. Descriptive statistics were generated using Microsoft Excel.
RESULTS
Of 1,164 patients screened, 12 met inclusion. Supplemental 1 ( https://links.lww.com/JAAOS/B412 ) outlines demographic, injury, and outcome data. Six patients met polytrauma status. Five of our 10 patients not lost to follow-up developed infections; two underwent below-knee amputation. Of seven patients treated ultimately with limb salvage, three required flap coverage and two patients presented with delayed wound healing. Five treated with limb salvage had continued pain at last follow-up, six used an assistive device for ambulation, and four reported continued sensory disturbances.
CONCLUSION
No consensus approach to heel pad degloving injuries exists. Our study highlights the largest case series to date regarding the treatment and outcomes of this rare injury.