Surgical Treatment of Non-Diabetic Chronic Osteomyelitis Involving the Foot and Ankle

Background: We evaluated the clinical characteristics and treatment outcomes of patients with chronic osteomyelitis in the foot and ankle in patients without diabetes. Methods: We reviewed 15 patients treated for chronic osteomyelitis involving the foot and ankle between September 2004 and March 2007. Patients with diabetes mellitus or who were immunocompromised were excluded. The cause of osteomyelitis, sites of occurrence, causative pathogens, and invasion of the adjacent joint(s) were reviewed, then the clinical characteristics were analyzed. Magnetic resonance imaging was performed to clarify the extent of infection and invasion of the adjacent joint. Surgical management included wide debridement, dead space control, and arthrodesis if there was invasion of the adjacent joint. The mean postoperative followup period was 3.3 years, during which recurrences and complications were evaluated. Results: Extrinsic causes accounted for 86.7% of the chronic osteomyelitis involving the foot and ankle. The most common cause of osteomyelitis was trauma with ten cases due to complications following fractures or dislocation. Methicillin-resistant Staphylococcus aureus and Pseudomonas were the most common causative pathogens. In 46.7% of the patients, the adjacent joint was involved and an arthrodesis was performed. The mean length of the hospital stay was 39.1 days. The average of number of surgeries was two. Fourteen of 15 patients had no recurrence. Conclusion: For the successful treatment of chronic osteomyelitis involving the foot and ankle, an arthrodesis based on invasion of the adjacent joint as well as wide debridement and dead space control was successful in this series.

Level of Evidence: IV, Retrospective Case Series