Limb Salvage Using Local Antibiotic Beads for Calcaneal Osteomyelitis With Multidrug-resistant Infection and Chronic Limb-threatening Ischemia.

Calcaneal osteomyelitis in diabetic patients with chronic limb-threatening ischemia (CLTI) and multidrug-resistant (MDR) infection poses a significant reconstructive challenge. Limited perfusion, high plantar loading, and constrained antimicrobial delivery often narrow salvage options and increase the risk of major amputation. We report a case of recurrent calcaneal osteomyelitis in a 53-year-old man with type 2 diabetes, chronic kidney disease, peripheral vascular disease, CLTI, and polymicrobial MDR infection. Management included revascularization, serial debridement, culture-directed systemic therapy, negative-pressure wound therapy, hyperbaric oxygen therapy, structured offloading, and adjunctive local antibiotic delivery using calcium sulfate beads. Following recurrence, repeat calcaneal debridement and saucerization were performed, and vancomycin- and gentamicin-loaded calcium sulfate beads were placed individually into the calcaneal defect. The wound progressed with no recurrent infection or exposed bone. Complete epithelialization was achieved at 14 months, and the patient remained pain-free and independently ambulatory in offloading footwear. In recurrent calcaneal osteomyelitis complicated by CLTI and MDR infection, calcium sulfate antibiotic carriers may serve as a useful adjunct to staged multimodal limb salvage. By combining dead-space management with high local antibiotic delivery after repeat debridement, this approach may be considered in selected ischemic, infection-resistant presentations.