A Difficult Case in a Patient with Diabetic Neuropathy and Prolonged Equinus Deformity

Introduction: Peripheral neuropathy is a challenge in a patient suffering from osteomyelitis. We present a talar osteomyelitis case of a lady suffering of Diabetes Mellitus, peripheral neuropathy, schizophrenia and long standing spinal dropfoot with subsequente equinus deformity in the involved foot.

Case Presentation: We present a 54 years old , diabetic, schizophrenic, obese female patient who suffered of long standing radicular drop foot and resultant equinus deformity in right foot , with right ankle septic arthritis and talar osteomyelitis according to clinical scenario, radiologic evaluation and histologic examination.

Suggested amputation refused by the patient guardian, consequently initially managed with three ankle arthrotomies, debridement and rinsing. An isolation of MRSA, K.pneumonia from the cultures.

IV antibiotics initiated , guided by infectious disease specialist and sensitivity panel, without improvement

As a salvage procedure, she underwent a single stage talectomy, excision of the upper calcaneal surface and the distal surface of the tibia. An antibiotic impregnated methylmethacrylate beats were inserted. Application of external circular frame.

A serial debridement procedure needed later on along with IV antibiotics for 8 weeks.

The inflammation signs disappeared and the cement was replaced in three weeks time. Following additional three weeks the cement was removed and the patient started to bear weight.

A one week episode of temperature flare up was not correlated with inflammation signs and regarded as hyperthermia of anti- psychotic drugs and anesthesia.

Results: At 8 months follow up the patient is infection free, bearing weight with satisfactory functional results despite 3 cm shortening

Conclusion: We suggest considering single stage talectomy with circular frame external fixation as a salvage procedure in similar cases