PMC3464045_01
Initial clinical presentation of the left foot with associated erythema, edema, draining deep abscess (A). Radiographic imagining does not show underlying breakdown of bone suggestive of osteomyelitis or Charcot foot (B). Surgical debridement involving entire medial plantar foot as well as sub-metatarsal soft tissue (C). Clinical appearance of healed tissue following negative pressure wound therapy and split thickness skin graft (D).
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The overall musculoskeletal appearance of the foot did not demonstrate any significant abnormalities or structural deformities (Fig. 1A). Radiographic imaging of the foot revealed peri-articular osteopenia about the fifth metatarsophalangeal joint, with subtle periosteal reaction, adjacent soft tissue swelling, and soft tissue gas, compatible with severe infection (Fig. 1B). The overall debridement involved much of the plantar medial and plantar forefoot area tissue but did not involve removal of bone (Fig. 1C). This continued until complete healing was observed at 8 weeks (Fig. 1D).
PMC3464045_02
Initial clinical presentation of the left foot, revealing plantar ulceration and necrotic destruction of the medial skin with gas in tissue (A). Radiographic imagining reveals diffuse gas in tissue and underlying breakdown of bone suggestive of osteomyelitis and Charcot foot (B). Surgical debridement involving the medial and plantar foot including bone (C). Clinical appearance of healing below the knee amputation (D).
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Frankly malodorous discharge and sinus tracking to well-circumscribed necrotic gas-filled bulla of the medial foot were also evident (Fig. 2A). Radiographic findings demonstrated gas in the dorsal and medial foot, significant soft tissue edema, and osseous breakdown of the midtarsal bones with osteolytic erosions at the level of the ulceration suggestive of osteomyelitis (Fig. 2B). Once adequate debridement was achieved, the foot was irrigated with copious amounts of antibiotic treated saline solution (Fig. 2C). Two weeks after the amputation, healing was unremarkable, and the skin sutures were removed (Fig. 2D).