Soft tissue inflammation of the lower limb and foot following tibiotalocalcaneal arthrodesis for osteoarthritis in a morbidly obese patient: A case report

RATIONALE: Tibiotalocalcaneal arthrodesis (TTCA) is a radical orthopedic procedure performed in patients with severe ankle and subtalar joint deformities, loss of limb support function, and chronic pain. TTCA in obese patients with multiple comorbidities carries a particularly high risk of postoperative complications. Reporting such cases helps highlight potential challenges and guide clinical management. PATIENT CONCERNS: We present a case of a 64-year-old morbidly obese patient (BMI 49.3 kg/m²) with a history of bariatric surgery who underwent TTCA. DIAGNOSES: Surgical site infection is a common early (around 3%) and late postoperative complication (up to 60%) following TTCA. INTERVENTIONS: The patient was treated with targeted antibiotic therapy, surgical debridement with resection of necrotic tissue, and placement of a Tiersch graft, which fully healed within 7 weeks. OUTCOMES: Nine months after surgery, the patient developed soft tissue inflammation in the lower limb and foot as a late complication associated with the intramedullary heel nail used during TTCA. LESSONS: Combined surgical and antibiotic treatment allowed complete healing and return to full physical activity. This case emphasizes that pantalar arthrodesis in obese patients with multimorbidity carries a significantly higher risk of surgical site infection and requires careful perioperative management.