Question

Foot  

Foot   I I had a bone spur removed from the top of my foot 7 weeks ago as it was causing an ulcer from rubbing. About 10 days post op, the surgeon put a waterproof bandage on my foot about 24 hours later I removed the bandage as it was very itchy. Within 2 days, my foot looked like this.  The foot eventually quieted down, but 10 days ago, the doctor said that I had "spit a stitch" and removed it. I was instructed to keep the area covered and apply antibiotic ointment.  6 days ago when applying the ointment, the area opened. Today,
5 days later the area has not completely healed but is substantially better than it
Had been.
A culture taken in the office 2 weeks ago showed NON MRSA staph. I was put on antibiotics. The area is less red but 8 weeks post op has not completely healed. The doctor is now ordering an MRI with and without contrast.  How likely is it that I have a bone infection?"  If the foot finally heals this time, does that mean that there is no infection or could there still be an infection?

Answer
Hi Roxy,

First of all I am sorry that you have to endure this ordeal.  Surgery sometimes has its complications and it sounds like your doctor is trying to manage them as best as possible.  So, from the picture it looks like the wound never closed fully and that you have some residual redness and swelling.  Clinical signs of inflammation are rubor (redness), calor (warmth), dolor (pain), tumor (swelling) and functio lasea (loss of function). If their is puss present and any of the cardinal signs then I think the decision to place you on antibiotics is fair.  The wound is open and so I would recommend treating this like a typical ulcer.  I would be off your foot as much as possible, to attempt to take tension off of the wound and facilitate wound healing.

In answering your question:  Yes it is possible to have a bone infection but not likely.  If your doctor attained an x-ray of your foot and he/she is noticing changes from the preop radiographs when compared to the post op radiographs, then an MRI is a good idea. It is better to be safe than sorry.  The MRI will show inflammation of the bone and technically there will be some because you just had surgery a few weeks ago. Your doctor and radiologist will have to determine if there is any boney erosion.

Blood tests help to determine infection as well especially if you have a fever or any other constitutional symptoms.

The gold standard in diagnosing osteomyelitis (bone infection) is taking a bone biopsy.  If the wound is open and probes to bone then it might be a good idea to take a bone biopsy. If there is a high suspicion for bone infection then a conversation regarding biopsy should be in effect.

I wish you all the best and hope this wound closes without any more complications.

Best Regards,

Dr. Jairo Cruz Jr.