Unusual presentation of calcaneal osteomyelitis. Twenty-five years after inoculation

Abstract

An unusual presentation of calcaneal osteomyelitis is described, where-by the infection remained undiagnosed for 25 years. The 36-year-old patient recently sought medical treatment for a reported ankle sprain, but the pain was recalcitrant to conservative care. Further investigation yielded a history significant for stepping on a chicken bone as a child, which entered the inferior lateral heel. Magnetic resonance imaging revealed what plain radiographs did not: a well demarcated lytic lesion in the body of the calcaneus. Intraoperative findings were consistent with an abscess of chronic osteomyelitis. The treatment included incision and drainage, antibiotic beads, and a tricortical bone graft.

An Incidental Finding of an Intraosseous Metallic Object Within the Os Calcis

“…Foreign bodies in the foot if left untreated can lead to soft-tissue infections, 5 and in some cases, can result in osteomyelitis, as illustrated in a case report by Rogoff et al in 1997. 6…”

“…She had initially presented 25 years previously after stepping on a chicken bone, which unfortunately was only partially removed by emergency services, and required surgery to remove a further 40 mm of chicken bone from her calcaneus 6 months after the initial incident. 6…”

“…On the other hand, by treating conservatively, there is a risk of future complications as illustrated by the case report by Rogoff et al, 6 such as abscess formation with osteopenia or osteomyelitis. There is also a long-term risk of possible migration of the foreign object into the subtalar joint.…”

An Unusual Cause of Heel Pain in a Young Athlete: A Case Report

“…All puncture‐related cases had cultures positive for Pseudomonas aeruginosa [1]. Other pathogens reported in puncture‐wound‐associated osteomyelitis include Serratia marcenscens (from chicken bone) [5], typhoid (nail in Israel) [6], Mycobacterium fortuitum (rake) [7], Pasteurella pneumotropica (creek bed in U.S. Midwest) [8], as well as Mycobacterium tuberculosis and Kingella kingae [2]. There is also a case report of staphylococcal calcaneal osteomyelitis after repeated injections for plantar fasciitis in a 71‐year‐old man [9].…”