Abstract
Osteomyelitis after trauma or surgery can be problematic, especially pedal osteomyelitis including calcaneal osteomyelitis. Here we report the results and problems associated with surgery for pedal osteomyelitis in five patients (four men and one woman). The mean age of the patients was 37 years (range 12-51 years). Four developed infection after surgery and one after contusion. Treatment involved thorough debridement of the infected area and filling of the dead space with artificial bone or cement beads incorporating a DDS (Drug Delivery System). Until the infection had subsided, we repeated this operation every 3 to 4 weeks. Finally, we performed a subtalar arthrodesis in one patient, a desis of the cuneiform bone in one, and auto-bone graft in three. The bacteria detected were MSSA in two patients, MRSA in three patients (including one case of MRSA combined with fungus). All of the infections subsided within a mean period of 9.6 months (range 5-21 months). The mean operation time was 3.2 hours (range 1-5 hours). We used mainly a DDS that released antibiotics from cement or artificial bone. There was no complication associated with this treatment. Since the calcaneus has poor vascularization and a large proportion of cancellous bone, pedal osteomyelitis, especially in the calcaneus, is challenging to treat. Filling the dead space using a DDS is effective for control of infection.
