Calcaneal Osteomyelitis: A Treatment Protocol.

Abstract

Calcaneal osteomyelitis poses a problem as any other chronic osteomyelitis in the body. Correct diagnosis and prompt treatment are essential to avoid limb-threatening amputation surgery. In this retrospective study, we describe the 4 golden principles of treatment of such cases through extended debridement, dead space management, soft tissue coverage and post-operative orthosis. We have studied 14 calcaneal osteomyelitis in 13 patients. Six of them were due to neuropathy. All the patients underwent debridement and sequestrectomy. Eight patients had instillation of calcium sulfate antibiotic granules in them. Silo technique was used in 10 patients. Total calcanectomy was performed in one case. Most of the patients were offloaded till their ulcers healed and were given custom orthosis to prevent recurrences. 13 cases had a successful result (P-value = 0.00092). One diabetic patient required a below-knee amputation. There were three cases of complications of re-ulceration, but it was not associated with calcaneal infection. The ulcers healed in 1.75 months (15 days-4 months). Insoles or ankle foot orthosis with hindfoot offloading were given to eight patients, while one patient required a silicon heel insole. Thorough debridement, dead space management and prevent of recurrences by offloading orthosis is necessary for limb salvage in calcaneal osteomyelitis.