Calcaneal osteomyelitis: an analysis of aetiology and pathogenic organisms

Abstract

Forty-nine cases of calcaneal osteomyelitis in 47 patients were evaluated between 1984 and 1993. Data on all osteomyelitis patients was collected prospectively in a computer data base. This data was reviewed to determine aetiology, pathogenic organisms and host characteristics of the patients. Aetiology was divided into five groups: diabetes mellitus (n = 21); central nervous system lesion (n = 10); post-traumatic (n = 9); nail puncture wounds (n = 5); and other (n = 2). Each case was staged using the Cierny-Mader classification for osteomyelitis: IIA (n = 3); IIB (n = 16); IIIA (n = 10); IIIB (n = 18); IVB (n = 2). Pathogenic organisms were categorized by each type of aetiology and host (A = uncompromised, B = compromised). Compromised hosts and patients with impaired sensation had more organisms cultured than uncompromised hosts. Treatment consisted of culture specific antibiotics (all); irrigation and debridement/partial calcanectomy (29); debridement with free flap (three); below knee amputation (10) and above knee amputation (one). All amputations were done in B hosts with impaired sensation. Eight of the 11 amputations were in diabetic patients. Patients with impaired sensation more commonly had multiple organisms cultured from their wounds and had a higher rate of amputation.