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Abstract
Introduction: Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis.Materials & Methods: A complete computerised and comprehensive literature search of Pubmed and Cochrane database was undertaken from January 2000 to October 2018. During the review, studies were screened for information about the surgical and antimicrobial treatment, the complications, the reinfection rate and the functional outcome of patients with calcaneal osteomyelitis.Results: Of the 20 eligible studies included, seven (35%) described bone treatment only, six (30%) soft tissue treatment only, five (25%) soft tissue and bone treatment, and two (10%) focused on prognostic factors and differences in outcomes between diabetic and non-diabetic patients.In the studies with bone treatment only, infection recurrence ranged from 0 to 35% and the amputation rate from 0 to 29%. If soft tissue coverage was also needed, both the reinfection rate and amputation rate ranged from 0 to 24%. Studies presenting the functional status generally showed preservation or even improvement of the preoperative ambulatory status.Conclusion: Calcaneal osteomyelitis is difficult to treat. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons and infectious disease physicians is preferred. The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice.
Highlights
Calcaneal osteomyelitis is an uncommon and challenging condition
The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice
Infection most commonly presents after a traumatic event or in patients with heel ulceration due to prolonged bed rest or lower limb neuropathy or vasculopathy (1)
Summary
Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis. Calcaneal osteomyelitis poses specific challenges for patients and treating clinicians. Infection most commonly presents after a traumatic event (open fractures or following fixation) or in patients with heel ulceration due to prolonged bed rest or lower limb neuropathy or vasculopathy (1). The diagnosis is primarily based on clinical features (unilateral localized swelling, erythema, localized pain, increased limb temperature, sinus or heel ulceration). Infection within the bone rarely causes sub-periosteal abscesses, but rather erodes through the specialised skin producing ulceration and skin loss (3). For successful treatment of calcaneal osteomyelitis (infection control and good functional http://www.jbji.net outcome) the following objectives should be delivered:
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