- See:
diabetic foot menu:
- Discussion:
- see
osteomyelitis:
- dx of osteomyelitis can be a difficult problem in diabetic pts w/ foot infections;
- some physicians will make the dianosis of osteomyelitis if they can palpate bone thru the skin lesion;
- this method is quick, inexpensive, and generally accurate;
- if there is not a lesion over the area of question, then it is more likely that the lesion
has resulted from Charcot changes;
- neuropathic osteoarthropathy often appears indistinguishable from OM, w/ multiple and widespread abnormalities
that can appear hot on all
three phases of a bone scan;
- peripheral vascular disease will also affect the uptake;
-
In-WBC may be most accurate for detection of OM in the diabetic foot;
- cellulitis is frequently present and can be confused with OM, esp if osteoarthritis or neuropathic disease is also present;
- references:
The septic foot in patients with diabetes.
Salvage of the diabetic foot with exposed os calcis.
Partial and total calcanectomy: a review of thirty-one consecutive cases over a ten-year period.
Osteomyelitis in the foot and ankle associated with diabetes mellitus.
Diabetic foot infections.
Wheat LJ et al.
Arch Intern Med 1986;146:1935-1940.
Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus.
Mowat A.
Baum J.
New England Journal of Medicine. 284(12):621-7, 1971 Mar 25.
- Offending Organisms:
- Aerobic
Gram Positive Cocci
-
Gr A strep (may cause acute sepsis)
-
Enterococci (may be most common);
-
Staph aureus
-
Enterobacteriaceae;
- references:
-
Microbiology of deep tissue in diabetic gangrene.
-
Aerobic and anaerobic bacteria in diabetic foot ulcers.
-
Quantitative aerobic and anaerobic bacteriology of infected diabetic feet.
-
Diabetic foot infections. Bacteriologic analysis.
-
Microbiology of superficial and deep tissues in infected diabetic gangrene.
- Eikenella corrodens as a cause of osteomyelitis in the feet of diabetic patients. Report of three cases.
Konugres GS.
Linda L.
Goldstein EJ.
Wallace SL. Journal of Bone & Joint Surgery - American Volume.
69(6):940-1, 1987 Jul.
- Management of Cellulitis or Infected Superficial Ulcerations:
- see
Wagner grading system for diabetic foot infections:
- non operative treatment is indicated for patients who are not septic;
- ie, no high fever, normal WBC, no altered mentation;
- cultures from ulcers are unreliable (need to treat based on deep cultures obtained from researach studies);
-
enterococci may be most common and therefore a
logical starting medication would be
Augmentin or
Unasyn;
- references:
Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.
Management of diabetic midfoot ulcers.
- Operative Treatment:
- surgical debridement is indicated for all patients who appear acutely toxic;
-
compartmental anatomy of the foot:
-
amputations in the diabetic patient:
- partial calcanectomy:
- may be indicated in certain situations in which there is exposed bone over the calcaneus and limited osteomyelitis,
and the only other alterantive is BKA;
- references:
-
Salvage of the diabetic foot with exposed os calcis.
- Partial calcanectomy for the treatment of osteomyelitis of the calcaneus.
TS Woll and RK Beals.
Foot Ankle. Vol 112. 1991. p 31-34.
-
Partial and total calcanectomy: a review of thirty-one consecutive cases over a ten-year period.
- Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis: An amputation of the back of the foot.
DG Smith et al.
JBJS. Vol 74-A. 1992. p 571-576.
The diabetic foot: evolving technologies.
Management of the diabetic foot.
Harrelson J: Orthop Clin North Am 1989;20:605.
Eikenella corrodens as a cause of osteomyelitis in the feet of diabetic patients. Report of three cases.
Konugres GS.
Linda L.
Goldstein EJ.
Wallace SL. Journal of Bone & Joint Surgery - American Volume.
69(6):940-1, 1987 Jul.
One-stage versus two-stage amputation for wet gangrene of the lower extremity: a randomized study.
Diabetic foot infections. Bacteriologic analysis.
Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections.
