Delayed recognition of pediatric calcaneal osteomyelitis: a case report

INTRODUCTION: The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. CASE PRESENTATION: A 9-year-old white boy presented to our institution with heel pain and an inability to weight bear. There was a 10-day delay in diagnosis of calcaneal osteomyelitis, with a total of three presentations to our emergency department. The condition was misdiagnosed as Sever’s disease on two separate occasions with discharge home. On his third presentation the diagnosis was finally clinched when he developed more definitive signs and symptoms, with pyrexia and signs of lymphangitis. Magnetic resonance imaging revealed diffuse osteomyelitis of his calcaneum. He underwent surgery and 2 weeks of antibiotics administered intravenously, followed by 4 weeks of oral therapy. We are happy to report a good recovery without any complications at his 12-month follow up. CONCLUSIONS: Physicians should include calcaneal osteomyelitis as a differential in any child presenting with heel pain. Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest.