title: Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis.
abstract: We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information.
authors.affiliation: Podiatry/Surgical Services, James A. Haley VA Hospital, Tampa, FL; New England VA Medical Center, VA New England Healthcare System, Bedford, MA.
authors.forename: Latricia L
authors.initials: LL
authors.lastname: Allen
authors.affiliation: New England VA Medical Center, VA New England Healthcare System, Bedford, MA.
authors.forename: Garrett
authors.initials: G
authors.lastname: Kalmar
authors.affiliation: New England VA Medical Center, VA New England Healthcare System, Bedford, MA; Departmenrt of Orthopedic Surgery, Brown University, Providence, RI; New Indications Discovery Unit, Wound Healing, Novartis Institute for BioMedical Research, Cambridge, MA; Association for the Advancement of Wound Care (AAWC), Malvern, PA; Wound Healing Center, RI Hospital, Providence, RI. Electronic address: drvdriver@aol.com.
authors.forename: Vickie R
authors.initials: VR
authors.lastname: Driver
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D061826:Foot Orthoses; D006801:Humans; D023821:Limb Salvage; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D010027:Osteotomy; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome; D014945:Wound Healing; D014946:Wound Infection / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*
chemical_list: D000900:Anti-Bacterial Agents
keywords: bone biopsy; calcaneal osteomyelitis; limb preservation; partial calcanectomy