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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Diagnosing diabetic foot osteomyelitis.

Eric M Senneville1, Benjamin A Lipsky2, Suzanne A V van Asten3

  • 1Gustave Dron Hospital, Tourcoing, University of Lille, France.

Diabetes/Metabolism Research and Reviews
|January 18, 2020
PubMed
Summary

Diabetic foot osteomyelitis (DFO) is a severe complication requiring prompt diagnosis. Combining clinical signs like probe-to-bone tests with X-rays aids early DFO detection, potentially preventing amputation.

Keywords:
biomarkersbone biopsydiabetes mellitusimaging techniquemicrobiologyosteomyelitis of the foot

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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.