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Spontaneous Bilateral Ankle and Midfoot Sepsis in a Nonimmunocompromised Patient

Thomas S. Roukis Weil Foot and Ankle Institute, Des Plaines, IL. Dr. Roukis is now with Madigan Army Medical Center, Tacoma, WA.

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Jeffrey R. Baker Weil Foot and Ankle Institute, Des Plaines, IL. Dr. Roukis is now with Madigan Army Medical Center, Tacoma, WA.

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Breck Tiernan Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA. Dr. Tiernan is now with Norwegian American Hospital, Chicago, IL.

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We describe a 70-year-old nonimmunocompromised woman with spontaneous bilateral ankle and midfoot sepsis and a deep-space abscess of the right lower leg. Salvage of both limbs was achieved by aggressive bilateral soft-tissue and osseous debridement, including a four-compartment fasciotomy of the right lower leg, antibiotic-loaded polymethyl methacrylate bone cement implantation, delayed allogeneic bone grafting of the osseous defects impregnated with autologous platelet-rich plasma bilaterally, and external fixation immobilization, implantable bone growth stimulation, and split-thickness skin graft coverage of the right lower leg, ankle, and foot. Osseous incorporation of the bone grafts bilaterally occurred 8 weeks after surgery. No soft-tissue or osseous complications occurred during the postoperative period or at 18-month follow-up except for arthrofibrosis in the right ankle; there was no evidence of recurrent abscesses, sequestrum, or wound-related problems. A review of the literature regarding bilateral pedal sepsis and the techniques used for limb salvage in this patient are presented in detail. (J Am Podiatr Med Assoc 96(2): 139–147, 2006)

Corresponding author: Thomas S. Roukis, DPM, Department of Vascular Surgery MCHJ-SOP, Madigan Army Medical Center, 9040-A Fitzsimmons Ave, Tacoma, WA 98431.