The diagnosis of diabetic foot osteomyelitis: examination findings and laboratory values

This study aimed to demonstrate how much examination findings and laboratory values can be helpful in the diagnosis of osteomyelitis in patients with diabetic foot infections.

Data of 46 consecutive inpatients prospectively followed up according to a specially designed "Diabetic Foot Follow-up Form" were analyzed. Following diagnostic interventions, clinical and laboratory findings of patients with and without a diagnosis of osteomyelitis were compared. In these patients with and without osteomyelitis confirmed by histopathology and/or microbiology and/or MRI the sensitivity and specificity of ESR (erythrocyte sedimentation rate) and wound size were also determined.

There was no significant differences in the duration of diabetes or the existence of nephropathy or vascular disease, while the other findings (ESR, C-reactive protein, wound size, history of diabetic foot ulcer, and retinopathy) were significantly different. It is found that ESR > or =65 mm/h together with a wound size > or =2 cm2 had a sensitivity of 83%, specificity of 77%, positive predictive value of 80%, and negative predictive value of 81% in the diagnosis of osteomyelitis.

This study demonstrated that simple clinical evaluation and laboratory findings without using expensive imaging methods may be important indicators of osteomyelitis.