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Infection in foot due to screw

by Ann
(Richmond)

I was diagnosed with a foot infection due to the screw in my toe coming loose, my concern is, if infection clears up won't it come back again because, the screw is still loose right? What are my options? I have had ongoing foot problems since 1995 and have had 4 surgeries. I had hammertoes bad, so had right foot done in 1995, after surgery they diagnosed me with CMT ( Charcot Marie Tooth disease) Had I known about that I wouldn't of had surgery in first place. I feel like I am walking on two different feet because, I never let them do left foot. My toes have been fused and, unfused I have 4 screw total 2 in second toe and, two in top of foot. I am in pain a lot, get callouses that are extremely painful but, about two weeks ago I noticed that my foot was hurting me then usual finally got into dr yesterday please give me an idea of options for this foot to prevent infection again.


RESPONSE

Hi Ann,

Yours in not an easy question to answer without actually examining you, but hopefully I can give you some insight.

Any time hardware is implanted in the body, it can become a focal point for infection. You do not mention how long you have had the screw in your toe, but if it was recent, then the infection could be from the surgery itself.

If the surgery was months or years ago, then the bacteria may have come from another source such as a recent respiratory infection.

I would argue that the screw is loose from the infection rather than the other way around. Once bacteria adheres to the screw and then possibly invades the surrounding bone, it is the resulting softening of bone that causes the screw to loosen.

So the big question is what to do? You are right in your question, that will the implanted screw continue to allow infections to occur in the toe. Perhaps an even bigger question is whether you can heal the infection at all with the implanted screw.

This is a decision your surgeon will have to make. In general, if the toe is well healed and the screw has served its function, then it makes sense to remove the screw. If, whatever purpose the screw was supposed to serve has not occurred, the screw may still have to be removed, but your doctor will have to come up with plan B as to what to do to stabilize the toe.

In mild infections, and again I have no idea how bad your infection is, you could go on antibiotics perhaps for as long as six weeks to see if the infection will clear up. You need this amount of time because it is harder to kill bacteria adhering to hardware. If that were to clear up your issue and months pass without a new infection, then perhaps you are home free.

On the other hand, if a long round of the proper antibiotic (antibiotics prescribed as a result of cultures, not just a broad spectrum antibiotic) does not lead to resolution of your problem, then you would certainly have to have the screw removed and actually surrounding bone to the screw may also have to be removed as it could be considered infected and a bone infection becomes a fairly serious issue.

As a side note, ask your doctor if any of the other screws are causing you part or all of the pain that you describe. If that is the case, it may make sense to have them removed as well.

Marc Mitnick DPM
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