From the Guidelines
Signs of foot infection that warrant further workup for osteomyelitis include a positive probe-to-bone test, exposed bone, a non-healing ulcer present for more than 2 weeks, deep or extensive ulceration, erythema extending beyond the wound margins, and persistent elevation of inflammatory markers despite appropriate antibiotic therapy, as recommended by the most recent guidelines 1.
Key Findings
- A positive probe-to-bone test is highly suggestive of osteomyelitis, especially in high-risk patients 1.
- Exposed bone, visible bone or joint, purulent drainage, and systemic symptoms such as fever or chills are also concerning findings that warrant further workup 1.
- Patients with risk factors like diabetes, peripheral vascular disease, or immunocompromised states should be evaluated with a lower threshold 1.
Diagnostic Approach
- Initial workup should include plain radiographs, though these may be normal early in the disease process 1.
- If clinical suspicion remains high despite negative radiographs, advanced imaging such as MRI (most sensitive), bone scan, or CT scan should be considered 1.
- Laboratory tests including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein can support the diagnosis but are not specific 1.
- Bone biopsy remains the gold standard for definitive diagnosis, especially when the diagnosis is in doubt or determining the causative pathogen’s antibiotic susceptibility is crucial 1.
Importance of Early Detection
- Early detection of osteomyelitis is crucial as delayed diagnosis can lead to amputation, sepsis, and increased mortality, particularly in diabetic patients with foot infections 1.