Diagnosing diabetic foot osteomyelitis

Area of Science:

• Infectious Diseases
• Orthopedics
• Diabetology

Background:

• Diabetic foot osteomyelitis (DFO) is a severe complication of diabetic foot infections (DFIs).
• DFO significantly increases the risk of amputation, prolonged antibiotic therapy, and hospitalization.
• DFO requires a multidisciplinary approach due to its complexity.

Purpose of the Study:

• To outline the diagnostic approach for diabetic foot osteomyelitis.
• To emphasize the importance of early and accurate diagnosis for effective management.

Main Methods:

• Clinical suspicion based on severe DFIs and positive probe-to-bone (PTB) tests.
• Utilizing inflammatory biomarkers (e.g., erythrocyte sedimentation rate) and initial plain X-rays.
• Confirmation via bone biopsy (surgical or percutaneous) with microbiological analysis.
• Advanced imaging (MRI, nuclear techniques) for persistent diagnostic uncertainty.

Main Results:

• The combination of PTB test and plain X-ray is effective for initial DFO diagnosis.
• Microbiological documentation quality impacts antimicrobial therapy adequacy.
• Advanced imaging can improve biopsy localization and diagnostic yield.
• Molecular pathogen identification methods have not yet surpassed classic techniques for DFO management.

Conclusions:

• Early suspicion and diagnosis of DFO are crucial for limb salvage and optimal treatment.
• A stepwise diagnostic strategy, from clinical signs to advanced imaging and biopsy, is recommended.
• Accurate microbiological data guides appropriate antimicrobial therapy, especially in non-surgical cases.