Calcaneal osteomyelitis

Infection may reach the calcaneus through a deep heel wound, spread from nearby tissue or travel through the bloodstream. Delayed treatment can damage bone and surrounding soft tissue, so persistent heel symptoms with signs of infection should not be managed as routine soreness.

Calcaneal osteomyelitis can present with deep heel pain, swelling, warmth, redness or difficulty bearing weight. A wound may fail to heal or may drain fluid. Fever can occur, but its absence does not rule out bone infection, particularly when circulation, sensation or immune function is impaired.

Assessment includes the skin and wound, circulation, sensation and the depth and location of tenderness. Blood tests and imaging may support the diagnosis. A bone or deep-tissue sample may be needed to identify the organism and guide antibiotic selection; a superficial swab may not represent infection within bone.

Treatment is directed by a medical and surgical team and commonly involves antibiotics chosen for the suspected or identified organism. Damaged or infected tissue may need surgical cleaning. If infection or surgery leaves a bone defect, reconstruction may be considered after the team assesses infection control, blood supply and soft-tissue coverage.

Follow the prescribed wound-care and weight-bearing plan closely. Keep dressings clean and do not probe, soak or cut tissue from a heel wound yourself. Pressure relief may involve footwear, a device or limiting load. Managing blood glucose when relevant, supporting nutrition and stopping smoking can also help the healing environment.

Seek urgent medical care for a deep or worsening heel wound, spreading redness, pus, bad-smelling drainage, blackened tissue, fever, chills, confusion, rapidly increasing pain or new inability to bear weight. People with diabetes, poor circulation, reduced foot sensation or weakened immunity should arrange prompt review of any broken heel skin because significant infection may cause limited early pain.

Ask how the diagnosis will be confirmed, whether a deep sample is needed, and how antibiotic choice may change when results return. Clarify how much weight the heel can take, who will review the wound, which changes require an earlier visit and whether surgery is being considered to remove infected bone or restore support.