The diabetic sausage toe: Prevalence, presentation and outcomes

Area of Science:

• Podiatry
• Diabetology
• Infectious Diseases

Background:

• Diabetic foot infections present diversely, including osteomyelitis (OM).
• The 'sausage toe' presentation of diabetic OM is poorly understood.
• This study investigates the prevalence and characteristics of sausage toe in diabetic infections.

Purpose of the Study:

• To assess the prevalence and clinical signs of sausage toe in diabetic foot infections.
• To evaluate treatment modalities and outcomes for this specific presentation.
• To determine if sausage toe indicates deep infection and high OM rates.

Main Methods:

• Retrospective analysis of 82 diabetic toe infection cases.
• Diagnosis of OM using various methods, including MRI.
• Comparison of acute vs. chronic sausage toe presentations.
• Evaluation of treatment outcomes: antibiotics alone, conservative surgery, amputation.

Main Results:

• 24% of diabetic toe infections presented as sausage toe.
• Most common ulcer location: proximal interphalangeal joint of lateral toes.
• MRI confirmed OM in 87.5% of sausage toe cases.
• Successful treatment: 20% with antibiotics, 58% with conservative surgery, 45.8% required amputation.

Conclusions:

• Sausage toe is a prevalent and significant presentation of diabetic toe infections.
• This deformity strongly suggests deep infection and a high likelihood of osteomyelitis.
• Surgery is often essential for infection control and healing, particularly in chronic cases.
• Treatment outcomes did not significantly differ between acute and chronic sausage toe groups.