State-of-the-art update for diagnosing diabetic foot osteomyelitis: a narrative review

Area of Science:

• Podiatry
• Infectious Diseases
• Radiology

Background:

• Diabetic foot disease is classified into diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFO).
• DFI diagnosis is typically clinical, while DFO diagnosis has multiple established methods.
• Accurate DFO diagnosis is essential for effective treatment outcomes.

Purpose of the Study:

• To provide a narrative review summarizing updated data on diagnosing diabetic foot osteomyelitis (DFO).
• To highlight current diagnostic techniques and their indications for DFO.

Main Methods:

• Extensive literature search on PubMed and Google Scholar using keywords related to diabetic foot and osteomyelitis diagnosis.
• Review of diagnostic modalities including clinical signs, inflammatory markers, radiography, advanced imaging, and bone biopsy.

Main Results:

• The probe-to-bone (PTB) test and elevated inflammatory markers (e.g., erythrocyte sedimentation rate) are key clinical indicators.
• Plain radiography is a first-line diagnostic approach.
• Magnetic resonance imaging (MRI) and nuclear medicine imaging are valuable when initial diagnosis is uncertain.
• Transcutaneous bone biopsy, avoiding wound contamination, is necessary for definitive diagnosis.

Conclusions:

• Selecting the appropriate diagnostic tool based on clinical presentation and available modalities is crucial for successful DFO management.
• Accurate diagnosis through a combination of methods leads to favorable treatment outcomes in diabetic foot osteomyelitis.