Achilles Tendon Rupture and Chronic Osteomyelitis

This patient had an Achilles tendon rupture in 2015 while on vacation in the Bahamas. A mostly sensate IDDM … 4 surgeries later, and a finally healed Achilles tendon, unfortunately however left her with chronic osteomyelitis of her calcaneus. She was referred to us in 2019. At that point she had failed 3+ yrs of wound care, immobilization, antibiotics (both oral and IV), and was living with a draining sinus tract at her medial heel. I suggested to the patient further surgery. She had multiple MRI’s, and a CT scan demonstrating the chronic OM. She declined surgery however, and even cancelled after she scheduled with us twice, due to admitted PTSD from the ordeal spanning the course of 6 years. I suggested to her (not in order) we debride the bone through the sinus tract -take cultures, irrigate, excise the wound, fill the void with a non-phosphate antibiotic impregnated bone filler (Cerament), close with heavy suture, and hope for the best. After 2 years of deliberation under our care she finally agreed, and that’s what we did. A culture in our office taken from active purulence in 2019 grew Enterobacter Cloacae, the repeat culture in the OR in July of 2021 also grew Enterobacter Cloacae. We used Gent/Vanc for the Cerament, although Cerament does not recommend using Gent. During surgery as soon as we started to debride the bone with a small curette, a long, purulent strand of fiberwire shot out from the intramedullary canal. This answered the question of the non-healing tract.
She is now 2 months out from surgery, and doing great. Wound free for the first time since 2015.

Note; classic chronic OM cloaca as seen on CT.