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Advanced Imaging of the Diabetic Foot and Its Complications
Copyright 1999 T. Learch, A. Gentili. All rights reserved.
Revised: November 16, 2004.

ULCERS AND OSTEOMYELITIS

The vast majority of osteomyelitis in diabetic patients occurs directly adjacent to soft tissue ulcers. [Bamberger DM, et al]

If an ulcer is not present, osteomyelitis is unlikely.

Ulcers > 2 cm2 have a 56% sensitivity and a 92% specificity for diagnosing osteomyelitis [Newman LG et al].

Deeper ulcers are significantly more likely to overlie osteomyelitis than shallow ulcers (82% vs. 33%) [Newman et al]

Therefore, ulcer location, size, and depth need to be assessed as well as the underlying bone scrutinized.

Foot ulcers in diabetic patients occur in highly characteristic locations. The distribution of these ulcers corresponds closely to the distribution of osteomyelitis.

bulletPlantar to the 1st -3rd metatarsal heads
bulletPlantar and medial to 1st toe
bulletPlantar and lateral to 5th toe
bulletCalcaneal tuberosity

50-year-old woman with diabetes. Note ulcer of medial forefoot with adjacent, underlying osteomyelitis of the 1st metatarsal head. (Click on the image to see a larger version)

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Advanced Imaging of the Diabetic Foot and Its Complications
Copyright 1999 T. Learch, A. Gentili. All rights reserved.
Revised: April 29, 2006.
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