Diagnosing osteomyelitis in diabetes foot ulceration

Published Date: 19th July 2016

Publication Authors: Pendlebury H

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Aims

Although osteomyelitis is a common complication of diabetes foot ulceration (DFU), it presents a diagnostic challenge. The aim of this study was to determine the diagnostic modality used to confirm osteomyelitis in patients with DFU.

Methods

This was a retrospective observational study of patients with DFU complicated by osteomyelitis. Data were collected from the hospital's electronic database and included baseline characteristics, type of diabetes, clinical features, radiological investigations performed and the outcome of treatment.

Results

Forty-five patients (males 73%) with diabetes (Type 2 diabetes, 80%), mean age (SD) 66 (13) years, with DFU were diagnosed to have osteomyelitis. Duration of diabetes was 15 (12) years and HbA1c was 75.4 (25.3)mmol/mol at presentation. The majority (93%) of the patients had peripheral neuropathy and 29% had peripheral arterial disease. 51% ulcers were neuropathic, 11% ischaemic and 38% neuroischaemic ulcers. Osteomyelitis most often (76%) involved the phalanges. Most patients (98%) had foot X-ray and 29% had magnetic resonance imaging done. 32/45 (71%) patients had clinical features of osteomyelitis (sausage toe, probing to bone, exposed bone) and 34/45 (75%) had radiological findings of osteomyelitis. Ten (22%) had only clinical features of osteomyelitis and 12 (27%) had only radiological features. Osteomyelitis resolved with antibiotics in 73% of patients and minor amputation was required in 13%. 7% patients died before resolution of osteomyelitis. 

Conclusions

Both clinical and radiological features need to be considered in making a diagnosis of osteomyelitis. This study also highlights the importance of not waiting for radiological features before treatment for osteomyelitis is initiated.

Srinivas-Shankar, U; Howard, AM; Pendlebury, H; Mathews, M; Milligan, K; Ford, N; Khalathil, D. (2015). Diagnosing osteomyelitis in diabetes foot ulceration . Diabetic Medicine. 32 (Suppl S1), 151

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