CHSU Discovery

Foot wounds are important to be taken care of and treated early on as they may cause complex medical problems, including osteomyelitis. This can lead to difficult multi-faceted treatment options, even amputation. Preventing foot wounds, especially in patients with more complex medical histories may prevent life-altering foot amputations and mobility limitations, as more than half of all foot ulcers end up in amputation. We present the case of a young male with PMH of Charcot Marie Tooth (CMT) disease and a prior history of trans-metatarsal amputation of 5th digit bilaterally, who presented to the hospital complaining of wound to his right foot after a minor trauma. Patient was admitted on the inpatient service and diagnosed with osteomyelitis and cellulitis based on history, exam, labs, and imaging. He was managed with IV antibiotics initially. Due to metal in his foot, MRI could not be completed. CT scan could not rule out osteomyelitis. Triple Phase Bone Scan was performed and confirmed osteomyelitis involving the fifth metatarsal. Patient had a surgical debridement with I&D and bone biopsy. Wound culture grew staph aureus and simulans. His antibiotics were ultimately deescalated. PICC line was placed, and patient was discharged to a skilled nursing facility to continue IV antibiotics for 6 weeks. This case was an example of a foot wound that turned into osteomyelitis and required a multi-regimen treatment approach, including surgery. In patients with CMT disease, the complication of hereditary sensory motor neuropathy may pose an increased risk of osteomyelitis due to sensory deficits.