Integrative Management of Chronic Osteomyelitis (Asthi-Majjagata Vidradhi–Nadivrana) of the Great Toe: A Case Report

Background: Osteomyelitis is an inflammatory condition of bone begins as an infection of the medullary cavity, haversian system and extends to involve the periosteum of affected area. Causes like trauma, ischemia, foreign body can make bone susceptible for the infection. Key steps in management includes, surgical removal of infected bone and extended antibiotic therapy. However chronic and recurrent cases are more challenging to treat. Hereby an attempt is made to treat such chronic condition of 22-year-old history of osteomyelitis with integrated approach to support postsurgical recovery and to prevent recurrence; as such cases are rarely documented. Case presentation: A 55-year-old, male with chronic non-healing wound at base of left great toe presented with pus discharge, foul smell having history of trauma 22 years ago and underwent wound debridement twice, but symptoms persisted with discharging sinus resulting into chronic osteomyelitis. Intervention: Management includes amputation, antibiotics, local wound debridement with Apamarga ksharajala (caustic water), Priyangvadya Taila (oil) and internal medications like Mahamanjishtadi Kashaya (decoction), Arogyavardhini Vati (tablet), Panchatikta ghrita guggula (tablets). Patient was monitored for infection control, wound healing, pain reduction and improvement in quality of life. Outcome: The integrated approach led to significant clinical improvement showing reduced infection, healthy granulation tissue formation and pain control. Improvement in quantitative parameters was seen through reduced WBC, ESR count with complete healing of wound within 50 days and no recurrence or complications noted during follow up. Conclusion: Present chronic osteomyelitis case was managed through integrative approach combining Amputation, intravenous antibiotics along with ayurvedic intervention internally (Panchatikta ghrita guggula, Mahamanjisthadi Kashaya, Arogyavardhini vati) and externally (vrana-lekhana, dhoopana, dressing with medicated oil) given over a period of 50 days. Chronic cases like osteomyelitis in which recurrence chances are more and has showed limited response to allopathy management alone can be treated with integrated approach.