Diabetic Foot Osteomyelitis

Patients with uncontrolled diabetes are at increased risk for development of osteomyelitis, especially in the presence of neuropathy or venous or arterial insufficiency. S. aureus and beta-hemolytic streptococci are the predominant organisms, although other gram-positive or gram-negative aerobic or anaerobic bacteria may also be seen. Plain radiographs should be the initial test to evaluate for the presence of osteomyelitis, followed by MRI if negative. If there is a draining sinus, the "probe to bone" test should be performed with a sterile probe; if bone is palpated, the diagnosis of osteomyelitis is highly likely. Further evaluation of the diabetic patient should be to assess for vascular insufficiency with the use of ankle-brachial indices and transcutaneous oximetry. If significant compromise is found, arteriography followed by revascularization should be undertaken. Surgical debride-ment is again the cornerstone of treatment, along with antibiotics directed toward the causative microorganism.

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