Isolated osteomyelitis of the talus in a child is very rare incidence [1,2]. Children presenting with pain and limp to emergency department are predominantly investigated for pathologies of hip or knee, hence a condition originating from talus is frequently missed. A delay in its diagnosis are precursors to gait and bony deformity in future where the cost of disability is a huge burden to the patient. We present a case of osteomyelitis of talus where initially it was a missed diagnosis but due to awareness and alertness of the treating physician it was identified and treated early. CASE REPORTA 2 year old child presented to Emergency Department with pain and swelling of her left foot and ankle for 1 month. Her parents claimed the child had sustained what was initially thought as a superficial injury to the foot about 6 weeks earlier-hit by a stone while playing. Seen and treated by a general practitioner -no radiographs were done then. Over the subsequent month she experienced increasing swelling and pain-affecting mobility, with an occasional fever. During the initial admission, the foot was warm, tender and swollen till the ankle. There was no neurovascular deficit, open wounds or discharging sinus. Based on radiographic and clinical findings, a diagnosis of crack fracture of the left talus dome with overlying cellulites was made -secondary to the initial trauma . A broad spectrum antibiotic was started and the limb immobilized in a below knee backslab cast. She was discharged home after 2 days as the constituitional symptoms had resolved and cellulitis appeared to respond to the treatment-a review planned a week later. By the next follow-up the child could weight bear , the pain and erythema had subsided but swelling persisted. The antibiotics were continued for another week, and a 3 weekly review planned. At 9 weeks, in view of the persistent swelling and lytic changes obvious on radiographs a MRI was planned. Differentials were AVN and Osteomyelitis. The MRI , done 12 weeks from date of admission ( 18 weeks post trauma) was reported as Chronic Osteomyelitis with underlying pathological fractures.

Introduction Episacral Lipomata or the “back mouse” is a tender, fibro-fatty subcutaneous nodule found in the thoracolumbar fascia area in up to 16% of people. The “back mouse” can be a cause of significant low back pain in patients with associated disc disease, nerve root compression and facet hypertrophy. This is due to the particularly dense innervation with substance P positive free nerve endings in the posterior layers of the fascia. Material and Methods We studied the outcome of removal of the ‘back mouse’ in nine patients with twelve lipoma's (three had bilateral lipoma's). The diagnosis was made by clinical examination and all of the excised nodules were confirmed to be episacral lipoma on histo pathological examination subsequently. The outcome was measured with Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scoring. The average VAS reduced from 7.8 pre operatively to 4.8 post operatively. Results Six patients had improvement in ODI from moderate to minimal disability, one patient had improvement from severe to moderate disability and the ODI in three patients were unchanged. Seventy percent of the patients were happy with the outcome as the symptoms had significantly reduced despite having some other underlying spinal pathology. Conclusion In our opinion, episacral lipoma may be an unrecognized entity by both specialists and generalists and can be a treatable cause of low back pain. The excision provided relief to the compressive effect it had on the middle and posteriro layers of the lumbar fascia and the muscles it encloses. Marginal excision of a painful episacral lipoma may provide pain relief and improved lower back function in patients who are carefully selected for this procedure,