FOOT & ANKLE Copyright IC 1987 by the American Orthopaedic Foot and Ankle Society, Inc. Osteomyelitis of the Foot due to Actinomyces meyeri: A Case Report

Abstract

Anaerobic osteomyelitis occurs uncommonly with Actino-myces as a cause of approximately half of the reported cases. Although Actinomyces is a common organism in the mouth flora, it is an uncommon pathogen in osteomye-litis occurring in the extremity. The following reports the only known case of anaerobic osteomyelitis of the foot secondary to A. meyeri. Anaerobic osteomyelitis of the extremities occurs infrequently but when it does, the most frequent path-ogens are Actinomyces israelii or Bacteroides. We are reporting the only known case of a foot osteomyelitis secondary to A. meyeri. CASE REPORT A 50-year-old white man complained of pain and swelling over the dorsum of his right foot for 4 months. The patient had struck the dorsum of his right foot on a steel bar 4 months before with immediate pain and swelling. After 10 days the pain decreased slightly, and the swelling had localized itself to an area over the dorsal midfoot with an associated diffuse erythema. The patient stated that he had had several chiropractic manipulations for the problem without any relief, and no x-rays were taken. He denied any fever or chills, drainage,or any other traumatic incident such as punc-ture wounds or insect bites to the area in the past. He hadno other medical problems and had been taking no medications.The patient did state that 8 months before he had had a 2-week history of swelling over the same area without a precipitating traumatic event, and it had resolved spontaneously without treatment. X-rays taken at that time were normal. Examination revealed a well-appearing male but with very poor dentition and gingivitis. The extremity examination revealed an ill-defined3 x 3 em subcutaneous mass dorsally over the baseof the second and third metatarsals with a central area of fluctuance and surrounding cellulitis. The area • To whom requests for reprints should be addressed, at th