Osteomyelitis Of The Hallux

A 30-year-old male patient with type 1 diabetes diagnosed at the age of 11 years was admitted because of infected foot ulcers on his right hallux. He had a mild fever and a history of proliferative diabetic retinopa-thy and microalbuminuria. Diabetes control was poor (HBA1c: 9.5%). He reported a trauma to his left foot 2 months earlier when an object fell on his feet while working. A superficial ulcer had developed on the dorsal aspect of his right great toe; the ulcer had become infected because the patient felt no pain and therefore did not seek medical advice.

On examination, pedal pulses were normal. Severe peripheral neuropathy was found and the vibration perception threshold was 30 V in both feet. An infected right hallux with purulent discharge, necrotic tissue at the tip, and cellulitis were observed (Figure 8.19). A plain radiograph showed osteomyelitis involving both distal phalanges (Figure 8.20).

A culture of the pus revealed Pseudomans maltophila, Enterobacter cloacae and

Enterobacter Cloacae Symptoms
Figure 8.20 Osteolysis of the distal phalanx and condyle of the proximal phalanx due to osteomyelitis of the hallux. Plain radiograph of the foot shown in Figure 8.19
Osteolytic Toe

anaerobes, and the patient was treated with ciprofloxacin and ampicillin-sulbactam for 2 weeks, based on the antibiogram. An amputation of the right great toe was undertaken due to persistent osteomyelitis.

Keywords: Hallux; osteomyelitis; amputation

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Responses

  • cristoforo
    What is hallux osteomyelitis?
    7 years ago

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