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Infections of the Foot

- Diabetic Foot Infection

- Deep Puncture Wound:
    - puncture wounds most often result in staph aureus infections (most common organism), or pseudomonas infection (most common gram negative organism);
           - staph aureus is the most common organism in soft tissue infections, where as pseudomonas is the most common cause of calcaneal osteomyelitis arising from puncture wounds;
           - why pseudomonas infection is so common is unclear since intial cultures of the foriegn body will not grow pseudomonas;
    - puncture wounds of the forefoot often involve the MTP joints;
    - in most cases, these patients cannot be managed w/ medical therapy alone but will require formal incision and debridement;
           - essentially, it is up to the physician to prove that there is not retained foreign body (such as a piece of tennis shoe rubber) deep in the heel;
    - calcaneal osteomyelitis:
           - in the report by Rasool MN, et al (2001), 14 children (average 9 years) with primary hematogenous osteomyelitis of the calcaneus are reported;
                  - 4 were seen early and 10 late;
                  - clinical presentation was dramatic, with fever, pain, swelling, and fluctuance around the foot and ankle;
                  - the diagnosis was missed initially in 8 cases because the patients were treated for septic arthritis of the ankle, cellulitis, and subcutaneous abscess;
                  - 4 patients seen early healed well, with no complications;
                  - the 10 patients seen late had chronic osteomyelitis with growth arrest; shortening of the foot, limb length deficiency; fusion of subtalar, calcaneocuboid, and ankle joints; calcaneus and equinus deformity; avascular necrosis of the talus; and phalangeal loss;
                  - total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful salvage procedures avoiding ablation of the limb in chronic cases;
           - references:
                  - Partial and total calcanectomy: a review of thirty-one consecutive cases over a ten-year period.
                  - Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.
                  - Osteomyelitis of the calcaneum.
                  - Hematogenous Osteomyelitis of the Calcaneus in Children 

Complications of deep puncture wounds of the foot.

Management of pseudomonas osteochondritis complicating puncture wounds of the foot.

Source of Pseudomonas in osteomyelitis of heels.

The stubbed great toe: importance of early recognition and treatment of open fractures of the distal phalanx.

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