A Limping Child: On A First Look It Is Hip Or Knee In Origin
Isolated osteomyelitis of the talus in a child is very rare incidence. Children presenting with pain and limp to emergency department are predominantly investigated for pathologies of hip or knee, hence a condition originating from talus is frequently missed. A delay in its diagnosis are precursors to gait and bony deformity in future where the cost of disability is a huge burden to the patient. We present a case of osteomyelitis of talus where initially it was a missed diagnosis but due to awareness and alertness of the treating physician it was identified and treated early.

Case Report
A 2 year old child presented to Emergency Department with pain and swelling of her left foot and ankle for 1 month. Her parents claimed the child had sustained what was initially thought as a superficial injury to the foot about 6 weeks earlier- hit by a stone while playing. Seen and treated by a general practitioner - no radiographs were done then. Over the subsequent month she experienced increasing swelling and pain- affecting mobility, with an occasional fever. During the initial admission, the foot was warm, tender and swollen till the ankle. There was no neurovascular deficit, open wounds or discharging sinus. Based on radiographic and clinical findings, a diagnosis of crack fracture of the left talus dome with overlying cellulites was made – secondary to the initial trauma . A broad spectrum antibiotic was started and the limb immobilized in a below knee backslab cast. She was discharged home after 2 days as the constituitional symptoms had resolved and cellulitis appeared to respond to the treatment- a review planned a week later. By the next follow-up the child could weight bear , the pain and erythema had subsided but swelling persisted. The antibiotics were continued for another week, and a 3 weekly review planned. At 9 weeks, in view of the persistent swelling and lytic changes obvious on radiographs a MRI was planned. Differentials were AVN and Osteomyelitis. The MRI , done 12 weeks from date of admission ( 18 weeks post trauma) was reported as Chronic Osteomyelitis with underlying pathological fractures.

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