Table 2.

Consensus statements for initial diagnosis and selection of patients for operative management of diabetic forefoot osteomyelitis

Item	Statement	Mean rating
A-1	Identifying visible, chronically exposed trabecular bone visible within a forefoot ulcer is sufficient for establishing the diagnosis of DFO.	7.77
A-2	MRI and/or bone biopsy are preferred second-line diagnostic modalities to confirm the presence of DFO when X-rays and clinical exam alone are suspicious but not sufficient to diagnose DFO.	7.93
A-3	Systemic toxicity in the presence of DFO with associated soft tissue infection, represents an absolute indication for surgical resection of bone.	7.93
A-4	Bone resection is recommended when substantial cortical destruction, osteolysis, macroscopic bone fragmentation (sequestria), or necrotic bone is seen on X-ray.	7.69
A-5	Débridement/resection of bone is recommended when visible, chronically exposed trabecular bone is identified within a forefoot ulcer.	7.31
A-6	An open or infected joint space represents an absolute indication for surgical resection of bone.	7.29
A-7	DFO in patients with prosthetic heart valves represents an absolute indication for surgical resection of bone.	7.00

DFO, diabetic foot osteomyelitis.