Transform infected metatarsal head
Courtesy of Richard Lang BSc (Hons) MSc FRCPodS & Jason Nandlal BSc (Hons) MSc FRCPods, Podiatric Surgeon & Consultant Podiatric Surgeon, Bishop’s Stortford, Hertfordshire, UK
72-year-old female with a history of rheumatoid arthritis (managed with biologic therapy), Hx TIA, hypertensive and diverticulitis.
The patient had a 10 month history of non-healing wound under the 2nd metatarsal head. The ulcer was managed under the community Podiatry team for weekly dressing appointments.
MRI showed cortical destruction of the 2nd metatarsal head, signalling osteomyelitis. Tissue cultures grew Staphylococcus aureus. The patient underwent a resection of the 2nd metatarsal head through dorsal incision, STIMULAN mixed with gentamicin was placed in bead form.
After 4 weeks the wound had healed.
This case presented several challenges. The chronic wound was a result of abnormal loading forces and forefoot deformity caused by the longstanding aggressive rheumatoid arthritis. This condition was causing devastating full body problems, as for most of the duration of this wound, the patient’s biologic medication was suspended. The goal was to remove the infected bone and tissue and heal the wound in order to restart her biologic medication and reduce her global joint pain, stiffness and mobility challenges.
Note: See STIMULAN page for regulatory statements. MA0537R1
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