Case Study: Mid-foot Charcot foot with Osteomyelitis and Diabetic Ulcers
This 44-year-old male presented with right foot cellulites from an abscess and diabetic ulcers. This non-compliant, uncontrolled diabetic had Diabetic ulcers at the Charcot deformity of one-year duration with little outpatient care. His past medical history was significant for uncontrolled diabetes, obesity, non-compliance, Charcot deformity, and hypertension.
Initial c-reactive protein (CRP) was 28.8. The MRI of the right mid-foot had Charcot changes with increased abnormal marrow signal suggestive of osteomyelitis.
Subsequent surgical management was multiple Percutaneous calcaneal bone cortex incisions and placement of 10 ml’s of flowable (liquid) Cerament mixed with 1.0 gram of vancomyacin delivered directly to the area of mid-foot osteomyelitis (Figure 1). Standard wound care was followed to the diabetic ulcers.
The patient had an unremarkable post-operative course. The initial CRP of 28.8 decreased to 1.4 (normal range is 0-1.0) six weeks after surgery and all ulcers were healed. Six months after surgery there was minimal discomfort to the mid-foot, the patient was bearing full weight with diabetic custom-molded shoes with no ulcer reoccurrence as well as no osteomyelitis reoccurrence. (Figure 2)
Case provided by Dr. Jeffrey C. Karr
Initial c-reactive protein (CRP) was 28.8. The MRI of the right mid-foot had Charcot changes with increased abnormal marrow signal suggestive of osteomyelitis.
Subsequent surgical management was multiple Percutaneous calcaneal bone cortex incisions and placement of 10 ml’s of flowable (liquid) Cerament mixed with 1.0 gram of vancomyacin delivered directly to the area of mid-foot osteomyelitis (Figure 1). Standard wound care was followed to the diabetic ulcers.
The patient had an unremarkable post-operative course. The initial CRP of 28.8 decreased to 1.4 (normal range is 0-1.0) six weeks after surgery and all ulcers were healed. Six months after surgery there was minimal discomfort to the mid-foot, the patient was bearing full weight with diabetic custom-molded shoes with no ulcer reoccurrence as well as no osteomyelitis reoccurrence. (Figure 2)
Case provided by Dr. Jeffrey C. Karr
Figure One
Figure Two