Calcaneal Osteomyelitis Caused by Nail Puncture Wounds

Abstract

Plantar puncture wounds to the foot are a common injury. A small number (1.8%) of these puncture wounds become infected and progress to osteomyelitis. The purpose of this article is to report the cases of six patients who developed osteomyelitis of the calcaneus after a puncture wound to the heel caused by a nail. The characteristics of the patients, the pathogenic organism, and the outcome were studied. Patients who were healthy and had no systemic illness (N = 4) had only one pathogenic organism cultured, whereas patients who had systemic illness (diabetes mellitus, N = 2) had more than one pathogenic organism cultured. The only amputation in this group occurred in a patient with diabetes mellitus. It was concluded that diabetic patients who develop calcaneal osteomyelitis from a nail puncture wound are more likely to have multiple pathogens cultured. Furthermore, if a diabetic neuropathy is also present, the nail puncture wound may be the initial injury leading to a chronic ulceration, increasing the risk of amputation.

Clinical Characteristics and Treatment of Extremity Chronic Osteomyelitis in Southern China

“…In addition, scanty soft tissues surrounding the calcaneus also increase the risk of bone infection. Moreover, even puncture wound, medical injection, and insect sting are reported 24 – 26 to lead to calcaneal infections.…”

Osteoid Osteoma of the Great Toe Mimicking Osteomyelitis: A Case Report and Review of the Literature

“…Pain and swelling in the distal phalanx of the great toe may be attributed to a wide spectrum of diseases, such as benign and malignant bone neoplasms, cellulitis, and osteomyelitis. Osteomyelitis in the foot usually emerges as a complication of diabetes mellitus or due to progression of posttraumatic superficial infection [8]. Subacute osteomyelitis is characterized by insidious onset extremity pain, with no obvious finding of disease.…”

“…We reviewed English-language studies published between 1947 and 2012; 27 cases of osteoid osteoma in the phalanges of the toe were identified [4–6, 8, 21–39] (Table 1). Sherman [39] was the first to review the literature, finding six cases to which she added three of her own.…”

“…However, that study did not report any data regarding the age or gender of the patients or which toes were involved. Our review of the literature revealed 13 osteoid osteoma patients with great toe involvement (four in the proximal and nine in the distal phalanges) [6, 21, 22, 24, 25, 28, 30, 32, 34, 35, 37, 38], seven patients with the second toe involved (two in the proximal and five in the distal phalanges) [5, 23, 27, 33, 36], four patients with the third toe involved (two in the proximal and two in the distal phalanges) [29, 39], two patients with the fourth toe involved (in the distal phalanges) [8, 26], and one patient with involvement of the proximal phalanx of the fifth toe [31]. Eighteen patients were males and nine were females.…”

Diagnosis of a Radiographically Occult Calcaneus Fracture With Bedside Sonography

“…Calcaneus fractures account for approximately 60% of all foot fractures and may be associated with considerable disability and economic impact, as 20% of patients may be totally incapacitated for up to 3 years after injury 2 . The most serious potential complication of a calcaneal puncture wound is the development of osteomyelitis 3 . Although the risk of subsequent osteomyelitis from a calcaneal puncture injury is small (≈2% in one pediatric review 4 ), the required course of therapy may be extensive, including surgical debridement and prolonged antibiotic therapy.…”