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Delayed recognition of pediatric calcaneal osteomyelitis: a case report.

Mallia AJ, Ashwood N, Arealis G, Bindi F, Zamfir G, Galanopoulos I - J Med Case Rep (2015)

Bottom Line: The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days.The condition was misdiagnosed as Sever's disease on two separate occasions with discharge home.Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton-on-Trent, UK. alvinmallia@hotmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Transverse incision above os calcis to drain pus
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Fig5: Transverse incision above os calcis to drain pus

Mentions: After the MRI scan confirmed osteomyelitis of calcaneus, the patient was urgently taken to theatre for drainage of a left foot abscess and drilling of os calcis for osteomyelitis. A transverse incision was made and copious amounts of pus drained (sent for microscopy, culture, sensitivity, Gram stain and acid-fast culture; Fig. 5). The wound underwent a complete washout with 6 liters of saline, and the os calcis was drilled with a 4.5mm drill then washed-out further (Fig. 6). Aqueous iodine and ribbon gauze were used to gently pack the cavity and hold open the incision.Fig. 5


Delayed recognition of pediatric calcaneal osteomyelitis: a case report.

Mallia AJ, Ashwood N, Arealis G, Bindi F, Zamfir G, Galanopoulos I - J Med Case Rep (2015)

Transverse incision above os calcis to drain pus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4557822&req=5

Fig5: Transverse incision above os calcis to drain pus
Mentions: After the MRI scan confirmed osteomyelitis of calcaneus, the patient was urgently taken to theatre for drainage of a left foot abscess and drilling of os calcis for osteomyelitis. A transverse incision was made and copious amounts of pus drained (sent for microscopy, culture, sensitivity, Gram stain and acid-fast culture; Fig. 5). The wound underwent a complete washout with 6 liters of saline, and the os calcis was drilled with a 4.5mm drill then washed-out further (Fig. 6). Aqueous iodine and ribbon gauze were used to gently pack the cavity and hold open the incision.Fig. 5

Bottom Line: The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days.The condition was misdiagnosed as Sever's disease on two separate occasions with discharge home.Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Orthopaedics, Queens Hospital Burton, Burton-on-Trent, UK. alvinmallia@hotmail.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus