Calcaneal osteomyelitis

　　When the human body stands, the calcaneus is at the lowest position, affected by gravity, blood returns slowly, which is conducive to the停留 and reproduction of bacteria in the bone. After the epiphyses of adults close, hematogenous osteomyelitis often occurs in the vertebrae, iliac bones, or calcaneus where red bone marrow is concentrated. Lesions are formed in this area and expand to the surrounding areas. Since the periosteum of the calcaneus is tightly and firmly attached, it is rare to form a large subperiosteal abscess before the abscess ruptures, and it is easy to form a sinus tract after the cortex is ruptured.

　　The heel is the main bearing point of the body and is prone to friction. The calcaneal cortex is thin, and the periosteum is firmly attached to the bone tissue. Therefore, after the bone marrow inflammation, there is little stripping of the periosteum, and fewer shells are formed, while the most common is perforation. In addition, with less local soft tissue and poor blood supply, the dead space is difficult to heal. In addition, when calcaneal osteomyelitis occurs, the inflammation of the calcaneus can spread upwards along the Achilles tendon, causing complications such as infection of the muscles and muscle spaces in the posterior part of the lower leg.

　　Calcaneal osteomyelitis has an acute onset, often accompanied by high fever and swelling of the calcaneus. Due to increased intramedullary pressure, there is tenderness and percussion pain over the calcaneus. Early tomography or CT scan can show focal areas of decreased density. Since this area is cancellous bone with rich blood supply, dead bone formation is rare. With the progression of the disease, there can be more calcium deposition and new bone formation, resulting in increased bone density.

　　Calcaneal osteomyelitis seriously affects the patient's daily life, so it should be actively prevented. Calcaneal osteomyelitis is caused by traumatic factors, and there are no effective preventive measures. Paying attention to safety in production and life and avoiding injury is the key to preventing this disease.

　　The auxiliary examination methods for this disease can be tomography and CT scan. Early tomography or CT scan can show focal areas of decreased density. Since this area is cancellous bone with rich blood supply, dead bone formation is rare. With the progression of the disease, there can be more calcium deposition and new bone formation, resulting in increased bone density. After the bone marrow inflammation, there is little stripping of the periosteum, and fewer shells are formed, while the most common is perforation. In addition, with less local soft tissue and poor blood supply, the dead space is difficult to heal.

　　Due to the acidic condition of the tissue in the calcaneal osteomyelitis patient, excessive intake of acidic foods will aggravate the imbalance of acid-base in the body. Acidic foods include sugar, alcohol, fish, meat, poultry, eggs, and animal fats, while vegetables, fruits, tubers, and seaweed are alkaline foods. During this period, it is encouraged to drink more soup and achieve 'three lows' in diet, that is, low fat, low sugar, and low salt.

　　In the late stage of treatment, it is the growth period for bone and soft tissue repair, and at this time, it is appropriate to increase meat and high-protein diet. Special attention should be paid to nutritional deficiencies, especially those related to blood calcium. Due to the patient's long-term bed rest, limited outdoor activities, insufficient sunlight exposure, it is very easy to cause calcium deficiency. If the patient's long-term calcium deficiency is not corrected, it will damage the blood calcium homeostasis system.

　　For patients with calcaneal osteomyelitis, drinking can have direct or indirect adverse effects. Drinking can directly cause acceleration of blood circulation, dilation of blood vessels, leading to blood stasis and edema in the affected area, causing local tissue hypoxia and malnutrition. Ethanol consumes a large amount of vitamins during the oxidation process in the body, and long-term drinking can lead to alcoholic toxicity malnutrition and vitamin deficiency in the body.

　　The phosphoric acid in cola may be a cause of calcaneal osteomyelitis, research shows that phosphoric acid is harmful to bone tissue because it has an adverse effect on calcium metabolism and bone. On the other hand, young girls who drink cola may not consume enough milk, leading to a lack of calcium in the body and thus prone to calcaneal osteomyelitis.

　　Osteomyelitis of the calcaneus is the same as acute osteomyelitis in other parts, in addition to the use of effective broad-spectrum antibiotics, early window drainage is used to reduce intramedullary pressure to prevent the spread of infection. The focus is gently scraped off without scratching, otherwise, it will cause excessive damage to cancellous bone, and form a larger bone cavity, or enlarge the focus. The calcaneus is a load-bearing unit of the human body, so it is not advisable to move too early after surgery, and walking with weight can only be done after new bone formation.

　　The reason why osteomyelitis of the calcaneus is discussed separately as a special site or type of osteomyelitis is that it adopts conventional foot incisions and surgical methods, and the therapy is often unsatisfactory. The medial or lateral incisions on the foot are only used for soft tissue abscesses or acute osteomyelitis of the calcaneus 'window' drainage. In chronic calcaneal osteomyelitis, a special calcaneal plantar incision should be used. Usually, it is禁忌 to make incisions on the plantar surface of the foot, because the scar on the sole can cause pain when bearing weight. The Gaenslen incision is used to expose, which is a longitudinal incision made along the exact median line of the heel on the sole. Starting from the level of the base of the fifth metatarsal, extending backward to the distal end of the Achilles tendon, the calcaneus is split longitudinally, and the focus is cleared. Such treatment of calcaneal chronic osteomyelitis that is difficult to cure not only ensures sufficient drainage and a high cure rate, but also, after wound healing, the skin flaps on both sides are inverted and form a calcaneal pad, without pain when bearing weight. Even if there is an occasional uneven plantar surface of the heel, it generally will not affect walking by using insoles.