Decubitus ulcers: when to suspect osteomyelitis

Six nursing home patients developed pressure sores of the foot and ankle, complicated by osteomyelitis of the underlying bone. All patients had advanced multi-infarct dementia with multiple contractures, and were bedridden, debilitated, and nutritionally deficient. All had arteriosclerotic heart and peripheral vascular disease, and other chronic illnesses. The pressure sores progressed rapidly and did not respond to medical and surgical therapy. Cultures yielded organisms usually associated with pressure sores. Diagnosis of osteomyelitis was initially made by radiography and eventually confirmed surgically. Patients with osteomyelitis of the metatarsal bones responded well to intravenous antibiotics and local amputation; all survived. The two patients with osteomyelitis of the calcaneal bone died after a short course. The diagnosis of osteomyelitis of the foot associated with pressure ulcers requires a high index of suspicion when a pressure sore does not respond to medical and surgical therapy in the appropriate clinical setting.