Teaching Points
- Diabetic foot complications are the most common cause for non-traumatic lower limb amputation, with the presence of osteomyelitis increasing the risk of amputation.
- Physical examination and laboratory findings which have shown to be likelihood of osteomyelitis include bone on view or positive probe to bone; ulcer area >2cm2; ulcer depth >3mm; ESR >70mm/hr; ALP >135U/L or appearance of a "sausage" toe.
- Plain radiography of the foot is the initial imaging procedure for suspected osteomyelitis, but has poor sensitivity as osteomyelytic changes are delayed for 10-21 days following infection.
- Radionuclide scans have improved sensitivity and specificity over plain radiography.
- MRI is the most sensitive and specific imaging modality for diagnosing osteomyelitis, but it's use may be limited due to availability and high cost.
- Bone biopsy is the gold standard for diagnosing osteomyelitis. Culture of the causative pathogen(s) and their antibiotic sensitivities may be necessary to guide antibiotic therapy.
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