Hematogenous Calcaneal Osteomyelitis in Children

Abstract

Heel pain is a frequent complaint in children due to intensive school and leisure-time sports. Heel pain accompanied by inflammatory signs has to be considered as osteomyelitis until the opposite is proven. From 1980 to 1989, twenty children were treated for acute or subacute osteomyelitis of the calcaneus (OMC) at the Department of Pediatric Surgery of the Children's Hospital of Lucerne. The schema of investigation comprising laboratory work-up, x-rays, scintiscanning and aspiration of the focus makes quick and accurate diagnosis possible. Exogenous osteitis of the newborn and calcaneal apophysitis in children must be differentiated; this is a prime consideration. Treatment includes surgical interventions (curettage, drainage) and long-term antibiotics. The course of the disease can be shortened, complications become avoidable and the rate of recurrence is diminished.

Hematogenous Osteomyelitis of the Calcaneus in Children

“…aureus has been found to be the most common bacterial agent in hematogenous calcaneal osteomyelitis in this and other studies (4,5,10,21). Although P. aeruginosa occurred in one patient in this study, it is usually found in calcaneal osteomyelitis from puncture wounds (3,7,11,14,17,20).…”

“…The calcaneus has a "metaphyseal equivalent" region that borders the apophysis that is susceptible to hematogenous infection, like in long bones (16). An association with trauma has been reported in a few cases of calcaneal osteomyelitis (10,15,20,21). In this study 5 patients had a history of antecedent trauma.…”

“…Studies by Winniker and Schärli (21) noted that patients <2 years were equally affected. Puffinbarger et al (17) and Jaakkola and Kehl (10) also noted that patients with hematogenous osteomyelitis of the calcaneus tended to be younger on average (<4.5 years).…”

“…Acute hematogenous pyogenic osteomyelitis of the calcaneus is uncommon (1,10,20,21). The calcaneus has a "metaphyseal equivalent" region that borders the apophysis that is susceptible to hematogenous infection, like in long bones (16).…”

“…The diagnosis of the primary acute form is often delayed or missed (1,10,13,17,20,21). The complications of calcaneal osteomyelitis have received less attention in the literature.…”