Probing the Validity of the Probe-to-Bone Test in the Diagnosis of Osteomyelitis of the Foot in Diabetes

  1. Alison Shone, BSC,
  2. Jaclyn Burnside, BSC,
  3. Susan Chipchase, BSC,
  4. Fran Game, FRCP and
  5. William Jeffcoate, MRCP
  1. Department of Diabetes and Endocrinology, Foot Ulcer Trials Unit, City Hospital, Nottingham, U.K.
  1. Address correspondence to William Jeffcoate, Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, City Hospital, Nottingham NG5 1PB, U.K. E-mail: wjeffcoate{at}

The ability to probe the base of a wound to periosteum or bone (the “probe-to-bone” test) is increasingly used to indicate the likelihood of underlying osteomyelitis. The original study (1) reported sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of 66, 85, 89, and 56%, respectively. However, this work has been criticized on the grounds of the high pretest probability of the disease (2), since the prevalence of osteomyelitis in the chosen sample (in-patients with clinically overt infection) was 66%. It follows that the usefulness of the test may be very different in less-selected populations. We have therefore determined …

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