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Editorial Commentary: Probe-to-Bone Test for Detecting Diabetic Foot Osteomyelitis: Rapid, Safe, and Accurate—but for Which Patients?

  1. Eric Senneville
  1. Infectious Diseases Department, Faculty of Medicine, French Reference Center for Osteo-Articular Infections (CRIOAC Lille-Tourcoing), Lille University 2, Gustave Dron Hospital, Tourcoing, France
  1. Correspondence: E. Senneville, Infectious Diseases Department, Faculty of Medicine, French Reference Center for Osteo-Articular Infections (CRIOAC Lille-Tourcoing), Lille University 2, Gustave Dron Hospital, 135 rue du Président Coty, Tourcoing 59200, France (esenneville{at}ch-tourcoing.fr).

Key words

(See the Review Article by Lam et al on pages 944–8.)

It is clearly established that osteomyelitis is a frequent complication of diabetic foot infections that jeopardizes the outcome of the patients affected by this disease [1]. Bone infection in this setting results from the spread of the (bacterial) infection of the soft tissues surrounding the foot ulcer to the underlying bone(s). Bacteria first reach the cortical part of the bone and then the medullar compartment. Metatarsophalangeal or interphalangeal joints are likely to be involved, which may result in their destruction. The usual indolent and unseen presentation of these infections may explain the delay with which the diagnosis of diabetic foot osteomyelitis (DFO) is generally made. Indeed, DFO may be present in the absence of clinical signs of infection of an ulcer, whereas DFO is exceptionally active in the absence of any overlying diabetic foot ulcer (DFU). The difficulties in diagnosing DFO usually lead to starting its management at an advanced (ie, chronic) stage. Due to histologic particularities and the role of biofilm, the chances of most antibiotics to sterilize the infected bone(s) appear to be limited and expose those patients to a high risk of relapsing DFO and, more importantly, of lower extremity amputation [2, 3]. As the prognosis of DFO and its management differ from that of diabetic foot soft tissue infection (DFI), it is therefore essential to detect the presence of bone involvement in those patients presenting with DFU and/or DFI [4].

The detection of bone involvement underlying a DFU is based first and foremost on the clinical examination of the foot that can be reinforced in case of elevated erythrocyte sedimentation rate and/or abnormalities on plain radiograph of the foot …

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