Osteomyelitis in the diabetic foot

Abstract

Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the diagnosis of OM in the diabetic foot combined with clinical and radiological studies.

Keywords: amputation; antibiotics; diabetic foot; infection; osteomyelitis; ulcer.

Fig. 1

Diagram of weight-bearing tripod of the foot.

Fig. 2

Probe-to-bone test for osteomyelitis in the diabetic foot.

Fig. 3

Plain radiograph. Evidence of cortical erosion of the fifth metatarsal head in a patient with osteomyelitis.

Fig. 4

MRI. T₂-weighted image – irregular ‘whitening’ of calcaneum suggests edema and osteomyelitis in a patient with a calcaneal ulcer.

Fig. 5

Bone scan. Bone scan showing increased uptake localized to the base of the fifth metatarsal, indicating osteomyelitis.

Fig. 6

Showing bones removed during a second ray amputation (second toe and partial resection of the second metatarsal).

Fig. 7

Diagram showing the bone resection for partial calcanectomy.