Treating Iatrogenic Calcaneal Osteomyelitis 
Following A Plantar Heel Injection


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Author(s): 
Michael Canales, DPM, FACFAS, Michael Bowen, DPM, and John Gerhard, DPM

   Researchers have reported that varying cleansing agents are effective at lowering the chance of infection if one uses them correctly. The most ubiquitous cleanser is isopropyl alcohol, which is reportedly effective for disinfecting the skin surface.17

   Cawley and Morris compared skin preparation solely with ethyl alcohol versus a combination of chlorhexidine and ethyl alcohol.18 After culturing the injection needles, the study authors found that the combination of chlorhexidine and ethyl alcohol resulted in contamination in 14 percent of needles and ethyl alcohol alone resulted in 28 percent contamination. Both agents resulted in lower contamination rates than the uncleansed control group, but the results did not meet statistical significance.

   Povidone-iodine solution should dry for at least three minutes after application. Studies have shown that povidone-iodine topical solution reaches its peak antiseptic potential when one allows it to air dry for 20 minutes.18 Some may view this as a less than ideal cleansing agent from a practical standpoint in a busy clinical practice setting.

   Both WHO and the Centers for Disease Control and Prevention (CDC) offer recommendations for safe injection practices and protocols that may limit contamination to medications and equipment.15,19 Proper hand hygiene remains the most important tool in the fight against healthcare-related infections. Wear gloves whenever the possibility of coming in contact with the patient’s blood exists. Use single-use vials whenever possible. If using multiple-dose vials, do not reuse needles or syringes. The WHO guidelines for skin preparation state that one should utilize single-use applicators. One should cleanse the skin with alcohol, beginning at the proposed injection site and cleansing outward without going over the same area twice. Cleanse the skin for a full 30-second interval and allow the alcohol to dry completely.

   Dr. Canales is in private practice at St. Vincent Medical Group in Independence, Ohio. He is the Associate Director of the PMR + RRA Residency Training Program at St. Vincent Charity Medical Center in the Department of Orthopedic Surgery, Podiatry Section in Cleveland. Dr. Canales is a Professor of Surgery at Kent State University College of Podiatric Medicine.

   Dr. Bowen is a third-year resident in the PMR + RRA Residency Training Program at St. Vincent Charity Medical Center in Cleveland.

   Dr. Gerhard is a third-year resident in the PMR + RRA Residency Training Program at St. Vincent Charity Medical Center in Cleveland.

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