Pseudomonas osteomyelitis of the metatarsal sesamoid bones.

It is unusual for osteomyelitis of the sesamoid bones to occur after a puncture wound to the foot. When the puncture occurs through tennis shoes, the risk of Pseudomonas infection is increased. Pseudomonas was the causative organism in 7 of 22 cases reported in the literature. This report will explore the causes and natural history, as well as the treatment, of these infections. Initially, basic wound care principles should be adhered to when treating these wounds. Patient awareness and close follow-up is important to ensure complete healing. Treatment of this case involved intravenous antibiotics and medial sesamoidectomy. Foot deformities can occur with sesamoid osteomyelitis and sesamoid excision. Hallux valgus deformity was noted to occur with the osteomyelitis and worsen with sesamoid excision. Preservation of surrounding structures during excision is important to prevent deformity.