Hematogenous osteomyelitis of the calcaneus in children

Fourteen children (average 9 years) with primary hematogenous osteomyelitis of the calcaneus are reported. Four 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. The 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. Hospital stay was prolonged in 4 patients. Total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful salvage procedures avoiding ablation of the limb in chronic cases.