Diagnosing Osteomyelitis in Patients With Diabetic Neuropathic Osteoarthropathy
- Devasenan Devendra, MB, CHB, MRCP1,
- Kim Farmer, MB, CHB2,
- Graham Bruce, BSC2,
- Philip Hughes, FRCR2,
- Gill Vivian, MRCP, FRCR2 and
- Beverley Anne Millward, MSC, MD, FRCP3
- 1University Medicine, University of Plymouth, Plymouth, U.K.
- 2Departments of Podiatry and Radiology, Derriford Hospital, Plymouth, U.K.
- 3Molecular Medicine Research Group, University of Plymouth, Plymouth, U.K.
Approximately 15% of diabetic people will develop foot ulcers during their lifetime, and early detection of osteomyelitis is crucial to the management of diabetic foot ulcers (1). Differentiating osteomyelitis from neuropathic osteoarthropathy is clinically difficult, as the symptoms and signs are nonspecific. These patients all present with hot and erythematous feet. At presentation, there is often no change on plain radiographs (2). Many of the imaging findings are also similar, especially in rapidly progressing, noninfected neuro-osteoarthropathy. The most reliable method of establishing infection is to analyze microbiological samples of the lesion. However, this is not always practical and may lead to seeding of …
