Neonatal osteomyelitis of the calcaneus following a heel pad puncture: a case report.

Osteomyelitis of the calcaneus developed in a 6-day-old girl subsequent to heel pad puncture for taking blood samples. A review of the literature indicates that as a complication, osteomyelitis is very rare, considering the thousands of punctures performed. There is no mention in the orthopedic literature of such cases being treated in neonatal units. The present case, like others reported thus far, is characterized by the benign course of the disease. Theoretically, it is possible that infectious process could spread from the heel primary site to other bones or joints. Some difficulty in early diagnosis may be encountered in the incipient stages of the disease because of the benign course and lack of radiologic findings. In such cases, when local findings and the history of heel pad punctures suggest an infectious process involving the bone, a bone scan is helpful inasmuch as it is positive before the radiologic signs become manifest. An adequate course of antibiotic therapy, immediately administered, is usually successful, with normal X-ray of the healed os calcis being evident after two to three months. Nevertheless, prophylactic therapy is strongly recommended.