title: 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.
authors.affiliation: Wright State University, Department of Orthopedic Surgery, Dayton, Ohio 45440, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Laughlin
authors.forename: F
authors.initials: F
authors.lastname: Reeve
authors.forename: D G
authors.initials: DG
authors.lastname: Wright
authors.forename: J T
authors.initials: JT
authors.lastname: Mader
authors.forename: J H
authors.initials: JH
authors.lastname: Calhoun
mesh_terms: D002111:Calcaneus / Q000293:injuries*; D002908:Chronic Disease; D005534:Foot Diseases / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology* / Q000628:therapy; D011552:Pseudomonas Infections / Q000209:etiology / Q000628:therapy; D014950:Wounds, Penetrating / Q000150:complications* / Q000209:etiology