The instep flap for coverage of calcaneal defects

Flaps used for skin coverage of the heel must be thick and sensitive in order to allow weight bearing and to avoid secondary ulcerations. We used the instep flap for 13 patients, 9 for diabetic foot skin loss and 4 with posttraumatic osteomyelitis of the calcaneus. The mean dimensions of the flaps were 6 x 5,5 cm. There were no vascular complications, and walking was possible after 4-5 weeks. The instep flap provided good quality and sensible skin, covering with ease the entire plantar surface of the heel. The instep flap is the best option to cover calcanean defects not exceeding the surface of the medioplantar region. This flap has the additional advantage of having the skin firmly attached to the plantar fascia, an important element in a weight bearing area and avoids microvascular anastomosis, important for the diabetic patients.