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Background: Calcaneal osteomyelitis is difficult to manage and requires a multidisciplinary approach. The aim of this study was to describe the characteristics and outcomes of calcaneal osteomyelitis, and to determine prognostic factors., Methods: This was an observational and retrospective study including all patients presenting with calcaneal osteomyelitis referred to a tertiary referral centre between January 2005 and December 2010., Results: Forty-two patients (mean age 50.7 y, range 22-89 y) were included. Fifteen were female. The mean duration of follow-up was 20 months (range 12-48 months). Twenty-six (62%) were post-traumatic osteomyelitis and 16 (38%) were secondary to neurological damage (sensitivity or motor impairment). All patients underwent surgical management with bone curettage and appropriate antibiotic therapy. Staphylococcus aureus was the most commonly isolated bacterium and was found in 29 patients. Polymicrobial samples were observed in 29 patients. Pseudomonas aeruginosa was associated with calcaneal osteomyelitis secondary to neurological damage (n = 7; 44% p = 0.045). Twenty-eight patients (66.7%) healed without the need to resort to amputation. The mean time to healing was 29 weeks with a range of 4-144 weeks. Relapse of bone infection occurred in 17 patients (40.5%). Seven patients (16.7%) required amputations. Favourable prognostic factors for healing without amputation were an American Society of Anesthesiologists (ASA) score < 2 (p < 10(-4)), post-traumatic calcaneal osteomyelitis (p = 0.001), age < 65 y (p = 0.02), absence of neuropathy (p = 0.005), and absence of diabetes mellitus (p = 0.02)., Conclusions: Calcaneal osteomyelitis is characterized by frequent relapse with delayed wound healing. Clinicians should take into account the impact of older age, as well as co-morbidities such as diabetes mellitus or the presence of neuropathy, during the routine management of patients with this difficult-to-treat bone infection.

Background: Melioidosis is an emerging infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei, which can lead to a range of clinical manifestations including acute septicaemia and chronic localized infections. Osteomyelitis is an uncommon but well-recognized complication of melioidosis, with the calcaneus being a relatively rare site of involvement. Case Description: The authors present a case series of three patients with calcaneal osteomyelitis caused by Burkholderia pseudomallei, infection. All three patients presented with non-specific symptoms like fever and weight loss, followed by localized ankle/foot pain and swelling. Diagnosis was made based on imaging findings (radiographs and MRI) and isolation of Burkholderia pseudomallei, from blood or pus cultures. Treatment involved a combination of initial intravenous antibiotic therapy (meropenem or ceftazidime) for 4-6 weeks, followed by oral trimethoprimsulfamethoxazole for 6 months. One patient required surgical drainage of a plantar abscess. All patients had a favorable clinical outcome with a resolution of osteomyelitis on follow-up imaging. Conclusion: Calcaneal osteomyelitis is a rare but potentially serious complication of melioidosis. Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for favorable outcomes. Clinicians should maintain a high index of suspicion for osteomyelitis in patients with melioidosis, especially in patients from Endemic areas as well as in patients with risk factors like diabetes. Close follow-up and monitoring for potential relapse or reactivation are essential, particularly in immunocompromised individuals. [ABSTRACT FROM AUTHOR]

Background: The treatment of chronic calcaneal osteomyelitis is a challenging and increasing problem because of the high prevalence of diabetes mellitus and operative fixation of heel fractures. In 1931, Gaenslen reported treatment of hematogenous calcaneal osteomyelitis by surgical excision through a midline, sagittal plantar incision. We have refined this approach to allow successful healing and early mobilization in a modern series of complex patients with hematogenous, diabetic, and postsurgical osteomyelitis. Methods: Twenty-eight patients (mean age 54.6 years, range 20-94) with Cierny-Mader stage IIIB chronic calcaneal osteomyelitis were treated with sagittal incision and calcaneal osteotomy, excision of infected bone, and wound closure. All patients received antibiotics for at least 6 weeks, and bone defects were filled with an antibiotic carrier in 20 patients. Patients were followed for a mean of 31 months (SD 25.4). Primary outcome measures were recurrence of calcaneal osteomyelitis and below-knee amputation. Secondary outcome measures included 30-day postoperative mortality and complications, duration of postoperative inpatient stay, footwear adaptions, mobility, and use of walking aids. Results: All 28 patients had failed previous medical and surgical treatment. Eighteen patients (64%) had significant comorbidities. The commonest causes of infection were diabetes ± ulceration (11 patients), fracture-related infection (4 patients), pressure ulceration, hematogenous spread, and penetrating soft tissue trauma. The overall recurrence rate of calcaneal osteomyelitis was 18% (5 patients) over the follow-up period, of which 2 patients (7%) required a below-knee amputation. Eighteen patients (64%) had a foot that comfortably fitted into a normal shoe with a custom insole. A further 6 patients (21%) required a custom-made shoe, and only 3 patients required a custom-made boot. Conclusion: Our results show that a repurposed Gaenslen calcanectomy is simple, safe, and effective in treating this difficult condition in a patient group with significant local and systemic comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. Case presentation: A 9-year-old white boy presented to our institution with heel pain and an inability to weight bear. There was a 10-day delay in diagnosis of calcaneal osteomyelitis, with a total of three presentations to our emergency department. The condition was misdiagnosed as Sever's disease on two separate occasions with discharge home. On his third presentation the diagnosis was finally clinched when he developed more definitive signs and symptoms, with pyrexia and signs of lymphangitis. Magnetic resonance imaging revealed diffuse osteomyelitis of his calcaneum. He underwent surgery and 2 weeks of antibiotics administered intravenously, followed by 4 weeks of oral therapy. We are happy to report a good recovery without any complications at his 12-month follow up. Conclusions: Physicians should include calcaneal osteomyelitis as a differential in any child presenting with heel pain. Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of the report was to present a 45-year-old lady who had a chronic osteomyelitis right calcaneum with a large non-healing ulcer and discharging sinus, treated by split-heel incision of Gaenslen. Objectives: Patients who have a recurrent ulcer of the heel often have a below-the-knee amputation because durable soft tissue coverage cannot be obtained over the calcaneus. Often, even if the ulcer heals satisfactorily or the area appears to be revascularized as a result of a peripheral vascular procedure, the resulting surface is not durable and the ulcer recurs. Gaenslen''s technique is recommended for refractory cases or patients with a draining sinus centrally located on the plantar aspect of the heel. An excellent functional result can be obtained. Method: Calcaneum was divided from posterior to anterior with a broad osteotome and split into two halves to expose the interior of the bone. Sequestra, infected material, necrotic slough damaged cortex were removed. The wound was closed loosely with a drain in situ. Result: The pressure sore and the surgical wound healing were remarkable at the end of 6 weeks. The heel had a deeply situated surgical scar and over which the surrounding tissues were laid, thus forming thick cushions. Conclusions: Split-heel incision of Gaenslen removed all sequestra, obviously infected matter and did little damage to the cortex. The resultant scar was painless and was so deeply situated that the tissues on either side curl inward to form ‘cushions’. [Copyright &y& Elsevier]