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A Clinical Sign of Underlying Osteomyelitis in Diabetic Patients

M. Lindsay Grayson, MD; Gary W. Gibbons, MD; Karoly Balogh, MD; Elaine Levin; Adolf W. Karchmer, MD

JAMA. 1995;273(9):721-723.

Abstract
Objective.
—To assess a bedside technique for diagnosing osteomyelitis.

Design.
—We prospectively assessed infected pedal ulcers for detectable bone by probing with a sterile, blunt, stainless steel probe. We then examined the relationship between detection of bone and the presence or absence of osteomyelitis that was defined histopathologically and/or clinically.

Setting.
—A tertiary care center.

Patients.
—Seventy-five hospitalized diabetic patients with a total of 76 infected foot ulcers were studied.

Results.
—Osteomyelitis was diagnosed in 50 instances (66%) and was excluded in 26 instances. Bone was detected by probing in 33 of 50 ulcers with contiguous osteomyelitis; in contrast, bone was probed in only four of 26 ulcers without contiguous osteomyelitis (P<.001). Bone detected on probing was visible in only three instances. Palpating bone on probing the pedal ulcer had a sensitivity of 66% for osteomyelitis, a specificity of 85%, a positive predictive value of 89%, and a negative predictive value of 56%.

Conclusions.
—Palpation of bone in the depths of infected pedal ulcers in patients with diabetes is strongly correlated with the presence of underlying osteomyelitis. If bone is palpated on probing, specialized roentgenographic and radionuclide tests to diagnose osteomyelitis are unnecessary. Probing for bone should be included in the initial assessment of all diabetic patients with infected pedal ulcers.

(JAMA. 1995;273:721-723)

Author Affiliations
From the Division of Infectious Diseases, Department of Medicine (Drs Grayson and Karchmer and Ms Levin), Division of Vascular Surgery, Department of Surgery (Dr Gibbons), and Department of Pathology (Dr Balogh), New England Deaconess Hospital, and Harvard Medical School (Drs Grayson, Gibbons, Balogh, and Karchmer), Boston, Mass. Dr Grayson is now with the Infectious Disease and Microbiology Department, Monash Medical Centre, Melbourne, Victoria, Australia.

Footnotes
Reprint requests to Division of Infectious Diseases, New England Deaconess Hospital, 185 Pilgrim Rd, Boston, MA 02215 (Dr Karchmer).

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