- Diabetic Foot Infection:
- Deep Puncture Wound:
- puncture wounds most often result in
staph aureus infections (most common organism), or
pseudomonas infection (most common gram negative organism);
- staph aureus is the most common organism in soft tissue infections, where as pseudomonas is the
most common cause of calcaneal osteomyelitis arising from puncture wounds;
- why pseudomonas infection is so common is unclear since intial cultures of the foriegn body will not grow pseudomonas;
- puncture wounds of the forefoot often involve the MTP joints;
- in most cases, these patients cannot be managed w/ medical therapy alone but will require formal incision and debridement;
- essentially, it is up to the physician to prove that there is not retained foreign body (such
as a piece of tennis shoe rubber) deep in the heel;
- calcaneal osteomyelitis:
- in the report by Mahomed Noor Rasool et al 2001, 14 children (average 9 years) with primary hematogenous
osteomyelitis of the calcaneus are reported;
- 4 were seen early and 10 late;
- clinical presentation was dramatic, with fever, pain, swelling, and fluctuance around the foot and ankle;
- the diagnosis was missed initially in 8 cases because the patients were treated for septic arthritis of
the ankle, cellulitis, and subcutaneous abscess;
- 4 patients seen early healed well, with no complications;
- the 10 patients seen late had chronic osteomyelitis with growth arrest; shortening of the foot,
limb length deficiency; fusion of subtalar, calcaneocuboid, and ankle joints; calcaneus and
equinus deformity; avascular necrosis of the talus; and phalangeal loss;
- total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful
salvage procedures avoiding ablation of the limb in chronic cases;
- references:
-
Partial and total calcanectomy: a review of thirty-one consecutive cases over a ten-year period.
-
Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.
-
Osteomyelitis of the calcaneum.
- Hematogenous Osteomyelitis of the Calcaneus in Children
Mahomed Noor Rasool, F.C.S.(SA)Orth. Journal of Pediatric Orthopaedics 2001;21:738-743
Complications of deep puncture wounds of the foot.
Management of Pseudomonas osteochondritis complicating puncture wounds of the foot.
Jacobs RF, Adelman L:
Pediatrics1982;69:432.
Source of Pseudomonas in osteomyelitis of heels.
The stubbed great toe: importance of early recognition and treatment of open fractures of the distal phalanx.
