Case Report: Distal tibial physeal injury secondary to conservative treatment of acute hematogenous osteomyelitis resulting in ankle deformity - highlighting the necessity of regular follow-up.

Ankle deformities most commonly result from physeal injuries following major trauma; those secondary to occult physeal injury without significant antecedent trauma are rarely documented. We report a case of ankle deformity in a 13-year-old boy resulting from distal tibial physeal injury following conservative treatment for acute hematogenous osteomyelitis(AHO) four years earlier; despite initial clinical improvement, the patient was subsequently lost to follow-up. At his return visit, significant ankle discomfort severely compromised daily activities. Following combined distal tibial osteotomy and distal fibular epiphysiodesis, the patient regained normal quality of life. This case highlights a frequently overlooked aspect of AHO in children: despite initial symptom resolution with conservative treatment, regular follow-up is essential to detect occult physeal injury and prevent irreversible deformity. Early diagnosis facilitates timely intervention and may obviate the need for osteotomy. In managing ankle deformity secondary to AHO, combined distal tibial osteotomy and epiphysiodesis effectively corrects the deformity while preserving subsequent growth balance, representing a reliable therapeutic option.