- See: diabetic foot menu
- 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;
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. Bacteriologic analysis.
Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus.
- Offending Organisms:
- Aerobic Gram Positive Cocci
- Gr A strep (may cause acute sepsis)
- Enterococci (may be most common);
- Staph aureus
- 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.
- 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;
- i.e., 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;
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;
- Salvage of the diabetic foot with exposed os calcis.
- Partial calcanectomy for the treatment of osteomyelitis of the calcaneus.
- 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.
The diabetic foot: evolving technologies.