Osteomyelitis is an infection involving the bones. Although cases can be seen in children and healthy adults, we most commonly see these cases in the diabetic population. Most diabetic patients have some sort of neuropathy, which results in loss of sensation to the foot. Glycemic control is directly related to the severity of neuropathy. Neuropathy also results in atrophy of the intrinsic muscles of the foot which give the larger and stronger muscles of the foot mechanical advantage which results in foot deformity. Charcot arthropathy is another complication of diabetes and neuropathy which results in foot deformity.
Once the deformity occurs, patients develop pressure points which results in the breaking down of the skin. The skin breakage creates an ulcer which then serves as an entry portal to bacteria. Once inside the tissue, the bacteria makes its way up to the bone which is exposed due to the ulcer and infects the bone.
These infections can either present as a local wound or in severe cases it result in a systemic infection resulting in sepsis which can cause multi-organ failure and even death. Inflammatory markers are tested in the blood along with wound cultures and blood cultures to tailor treatment to the specific infection. X-rays, MRIs and bone scans are often utilized to aid with diagnosis.
These infections are often very hard to treat. They require serial wound debridement's, IV antibiotics, bone debridement and in severe cases they result in amputation of the involved foot or limb. Amputation rates are higher in patients with poor glycemic control. It is a known fact that 50% of patients who undergo a below knee amputation will die within 5 years of amputation. The economic and social burden is also vast. Below is a small collection of pictures of infections we have seen and treated.
It takes a team of expert doctors including infection disease, vascular surgery, interventional cardiology, endocrinology, internal medicine and foot and ankle surgery to salvage a limb. Again, good glycemic control is key in recovery. Correction of deformity or offloading of the wounds is another important factor that is important to address.
If you or a family member has a simple or complex ulceration that has not healed or just recently developed we offer same day visits for these conditions as time is imperative.
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