J Yeungnam Med Sci.  2023 Oct;40(4):321-327. 10.12701/jyms.2023.00976.

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

• Woo I
• Cho SJ
• Park CH

• KMID: 2547354
• DOI: http://doi.org/10.12701/jyms.2023.00976

Abstract

Recently, the International Working Group on the Diabetic Foot and the Infectious Diseases Society of America divided diabetic foot disease into diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFO). DFI is usually diagnosed clinically, while numerous methods exist to diagnose DFO. In this narrative review, the authors aim to summarize the updated data on the diagnosis of DFO. An extensive literature search using “diabetic foot [MeSH]” and “osteomyelitis [MeSH]” or “diagnosis” was performed using PubMed and Google Scholar in July 2023. The possibility of DFO is based on inflammatory clinical signs, including the probe-to-bone (PTB) test. Elevated inflammatory biochemical markers, especially erythrocyte sedimentation rate, are beneficial. Distinguishing abnormal findings of plain radiographs is also a first-line approach. Moreover, sophisticated modalities, including magnetic resonance imaging and nuclear medicine imaging, are helpful if doubt remains after a first-line diagnosis. Transcutaneous bone biopsy, which does not pass through the wound, is necessary to avoid contaminating the sample. This review focuses on the current diagnostic techniques for DFOs with an emphasis on the updates. To obtain the correct therapeutic results, selecting a proper option is necessary. Based on these numerous diagnosis modalities and indications, the proper choice of diagnostic tool can have favorable treatment outcomes.

Keyword

Diabetic foot; Diagnosis; Osteomyelitis

Figure

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  Fig. 1. Diabetic foot osteomyelitis at left first proximal phalanx. (A) Plain X-ray shows an erosive, destructive lesion on the proximal phalanx of the first toe (arrow). (B) A lesion on the plain X-ray does not appear serious, but a high signal intensity is marked on the T2 fat suppressed magnetic resonance imaging.

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  Fig. 2. Osteomyelitis at the right second metatarsal bone. Positron emission tomography/computed tomography image illustrates diffusely increased fluorodeoxyglucose accumulation along the bone.

Reference

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