Hematogenous calcaneal osteomyelitis in children.

This study reviewed 21 cases of hematogenous osteomyelitis of the calcaneus in skeletally immature patients. The average patient age was 2.9 years. Local tenderness, swelling, and erythema were the most common findings. The erythrocyte sedimentation rate was elevated in 20 (95%) of 21 patients, whereas the C-reactive protein was abnormal in only seven (47%) of 15 patients tested. Nine patients had positive cultures, with Staphylococcus aureus being the most common organism. Plain films showed a lytic lesion in 15 (71%) of 21 cases, whereas scintography was positive in all 16 cases scanned. Ten patients were treated with antibiotics alone, whereas 11 patients underwent surgical irrigation and debridement in association with antibiotic therapy. Seventeen patients returned for follow-up, and although only one was symptomatic, three of 10 follow-up radiographs revealed residual abnormalities of the calcaneus.