Table 2.

This is a brief table reminding clinicians of the basics of approaching the diagnosis and treatment of suspected diabetic foot osteomyelitis. Please refer to the text for more detail.

Basic Approach to a Diabetic Person with Possible Foot Osteomyelitis.
Diagnosis - Clinical: wound size/depth; visible/palpable bone; soft tissue infection; PAD - Laboratory: WBC count; erythrocyte sedimentation rate; C-reative protein; procalcitonin - Imaging: Plain X-rays; advanced imaging if needed(MRI, radionuclide scans, PET/CT) - Cultures: Deep tissue specimens; bone specimen (surgical or transcutaneous) if possible
Treatment - Surgery   - Urgent if needed for soft tissue debridement, or pus drainage   - Elective in most cases if mainly for bone debridement, resection, or amputation   - Preferred primary approach for patients with: exposed bone or joint; necrotic soft tissue; fluid collection or abscess; advanced bone destruction; need for other surgical repairs; lack of response to antibiotic treatment; high risk for antibiotic resistant pathogens or antibiotic-related toxicity - Antibiotics - Empirical: Broad-spectrum, or targeted if available culture results, while awaiting results of culture and antibiotic sensitivity tests - Definitive: Baseed on: culture and antibiotic sensitivity results; clinical response to empiric therapy; and, antibiotic stewardship principles - Preferred primary therapy for patients with: infection confined to the forefoot; adequate limb perfusion; no tissue necrosis; contraindications to, high risk from, or patient preference to avoid, surgery - Adjunctive: no treatments of proven benefit