Diabetic patients with skin ulceration and/or soft tissue infection of the foot can be evaluated by a diagnostic algorithm.
(1) Is bone visible or can a probe be passed to bone through the lesion?
(2) Are plain radiographs compatible with osteomyelitis?
(3) Does the patient have severe peripheral neuropathy?
(4) Is there a high clinical suspicion for osteomyelitis?
(5) Is an In-111 leukocyte scan or magnetic resonance imaging consistent with osteomyelitis?
|
(1) |
(2) |
(3) |
(4) |
(5) |
Diagnosis |
|
Y |
|
|
|
|
presumptive osteomyelitis |
|
N |
Y |
N |
|
|
presumptive osteomyelitis |
|
N |
Y |
Y |
|
Y |
presumptive osteomyelitis |
|
N |
Y |
Y |
|
N |
negative for osteomyelitis |
|
N |
N |
|
Y |
Y |
presumptive osteomyelitis |
|
N |
N |
|
Y |
N |
negative for osteomyelitis |
|
N |
N |
|
N |
|
negative for osteomyelitis |
Treatment regimens
Presumptive osteomyelitis:
(1) Consider bone biopsy for culture or histopathologic examination.
(2) Consider resection of bone with antibiotic therapy for 2 weeks.
(3) Consider culture-guided antibiotic therapy for at least 4-6 weeks.
Negative for osteomyelitis:
(1) Treat for 2 weeks for the soft tissue infection.
(2) Consider follow-up plain radiographs to exclude undetected osteomyelitis.
Specialty: Infectious Diseases, Endocrinology
