Abstract
Research Type
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose
The treatment of osteomyelitis of the hindfoot is often complicated by bony and soft tissue defects and deformities of the foot. However, patient noncompliance and multimorbidity also complicate treatment. The literature mostly comprises studies with a small number of patients or case reports. We examined 59 affected patients between 2018 and 2024, 39 of whom met the inclusion criteria. Inclusion criteria were patients with an osteomyelitis of the hindfoot with and without foot ulceration, sufficient vascularity and no previous osteomyelitis treatment. The purpose of this study was to evaluate the achieved infection control, deformity correction and functional foot preservation.
Methods
Diagnostics included pre,- and postoperative MRI, CT examination of the foot. Bone samples and intraoperative swabs were used to confirm the diagnosis. Treatment consisted of infection control with sequestrectomy, vacuum therapy, Cerament implantation and antibiotic treatment appropriate to the resistance. Secondary treatment consisted of deformity correction and defect coverage.
Results
In 29 of 38 patients diabetes mellitus was present. 17 patients had a Charcot arthropathy of the foot. A foot ulcer was found in 29 patients. The mean number of surgical procedures was 4.2, with deformity corrections ( complex hindfoot arthrodesis (24%)), osteotomies (10%), tendon transfer procedures (13%), partial calcaneus resections with plastic coverage (5%), plantar exostectomies (5%) and arthroplasty (7%) following infection control. The mean follow up was 14 months. The complication rate was 52%, with 24% representing wound healing issues.
Ulcer recurrence occurred in 3 patients. Osteomyelitis treatment was successful in 35 patients (92%), with 7 patients showing a recurrence, which was successfully treated in 4 patients. Complete foot preservation was achieved in 35 patients (92%).
Conclusion
Osteomyelitis treatment of the hindfoot is a complex therapy with a high complication rate, which in most cases is worthwhile in terms of foot preservation and regaining mobility and quality of life for the patient.