Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging

Aims  To assess efficacy of conservative management of neuropathic forefoot ulcers with underlying osteomyelitis in subjects with diabetes when magnetic resonance imaging (MRI) is used to confirm or establish diagnosis and to guide antibiotic duration. Methods  A retrospective cohort study over 6 ye...

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Bibliographic Details
Published in:Diabetic medicine 2009-11, Vol.26 (11), p.1127-1134
Main Authors: Valabhji, J., Oliver, N., Samarasinghe, D., Mali, T., Gibbs, R. G. J., Gedroyc, W. M. W.
Format: Article
Language:English
Subjects:
Aged
Algorithms
Amputation
Anti-Bacterial Agents - therapeutic use
Biological and medical sciences
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - diagnosis
Diabetes Mellitus, Type 1 - therapy
Diabetes. Impaired glucose tolerance
diabetic foot
Diabetic Foot - diagnosis
Diabetic Foot - etiology
Diabetic Foot - therapy
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Feeding. Feeding behavior
Female
Forefoot, Human
Fundamental and applied biological sciences. Psychology
Humans
Incidence
magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Medical sciences
osteomyelitis
Osteomyelitis - complications
Osteomyelitis - diagnosis
Osteomyelitis - therapy
Retrospective Studies
Surgical Wound Infection - diagnosis
Surgical Wound Infection - etiology
Surgical Wound Infection - therapy
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
Wound Healing - physiology
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Summary:Aims  To assess efficacy of conservative management of neuropathic forefoot ulcers with underlying osteomyelitis in subjects with diabetes when magnetic resonance imaging (MRI) is used to confirm or establish diagnosis and to guide antibiotic duration. Methods  A retrospective cohort study over 6 years assessing rates of ulcer healing, relapse and amputation. Antibiotics were continued for 3‐month cycles with interval MRI: if the lesion had healed and bone signal change resolved or improved, antibiotics were discontinued; if the lesion had not healed or there was no difference in bone signal change, antibiotics were continued for a further 3‐month cycle; clinical or radiological deterioration resulted in endoluminal or open vascular surgical intervention where appropriate, or digital or more proximal amputation. Results  There were 53 episodes in 47 subjects (mean ± sd age 62 ± 13 years, duration of diabetes 19 ± 13 years, glycated haemoglobin 8.4 ± 1.6%; six with Type 1 diabetes and seven with end‐stage renal failure). Successful healing without relapse was achieved in 40 episodes (75%) [median (range) duration of antibiotics 6 (3–12) months and follow‐up post‐cessation of antibiotics 15 (3–58) months]. Relapse occurred in six episodes (13%) at 31 (2–38) months post‐cessation of antibiotics. There were one major (2%) and eight minor (15%) amputations. Five subjects have died (11%), all without foot ulcers. Conclusions  High rates of healing and low rates of amputation were achieved. The use of MRI was associated with long courses of antibiotics, but particularly low relapse rate.
ISSN:0742-3071
1464-5491
DOI:10.1111/j.1464-5491.2009.02828.x