LOWER LEG - Ulceration of skin with underlying fracture of os calcis

Over the inner aspect of the heel there is a large ulcer with sharply defined fibrotic margins. The base of the ulcer in its lower portion is formed by granulation tissue in which there is some haemorrhage; in the upper portion of the ulcer the floor communicates with a fracture in the os calcis.
This woman presented at the age of 48 with a one year history of an ulcer which would not heal. She had a long history of poorly controlled diabetes and she had had episodes of thrombophlebitis in that leg. The ulceration is assumed due to a combination of venous stasis and diabetic arteriopathy. The presence of a fracture was not accounted for in the history. The patient was grossly obese and had osteoarthritic changes in her hips and knees.