The Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine issued recommendations for the diagnosis of osteomyelitis in a patient with diabetic foot disease.
Patient selection: diabetic food disease
Outcome: diagnosis of diabetic foot osteomyelitis (DFO)
Recommendation
Description
attempt to probe to bone if there is an open foot wound
the ability to see or reach bone is presumptive evidence of osteomyelitis
perform serial plain X-rays of the foot
to identify bone lesions (destruction, deformity) and soft tissue changes (gas, presence of a foreign body)
additional imaging studies if indicated
MRI preferred (with leukocyte and bone scans performed if MRI not available)
bone culture and histology
specimens may be obtained during debridement or as a separate bone biopsy
Indications for additional imaging or bone studies:
(1) diagnostic uncertainty
(2) inadequate culture information
(3) failure to respond to appropriate empirical therapy
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