Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers.
Thirty-two diabetic patients with foot ulcers were evaluated. Twenty-five patients had foot radiographs, technetium-99m bone scans, and wound and bone cultures; the remaining seven patients had all the studies except bone scanning. Bone changes compatible with osteitis were present on 15 of 32 foot radiographs (47 percent) and on 16 of 25 bone scans (64 percent). Bacterial growth was present in 27 of 32 wounds (84 percent) and 23 of 32 bone cultures (72 percent). Twelve of 23 patients (52 percent) with positive bone cultures had evidence of bone destruction and periosteal reaction on radiographs. The remaining 11 of 23 patients (48 percent) without radiographic signs of osteitis had bacterial growth from their bone cultures. Bone scans were positive in 12 of 18 patients (67 percent) with positive bone cultures and negative in 6 of 18 positive bone cultures (33 percent). We conclude that neither foot radiographs, technetium-99m bone scans, nor wound cultures should be used as the sole criterion for determining the use of antibiotic therapy or amputation in diabetic patients with foot ulcers.
Shults
D W
DW
Department of Vascular Surgery, Tucson Veterans Administration Medical Center, Arizona 85724.
Hunter
G C
GC
McIntyre
K E
KE
Parent
F N
FN
Piotrowski
J J
JJ
Bernhard
V M
VM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D048909:Diabetes Complications; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging; D005534:Foot Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D011859:Radiography; D011877:Radionuclide Imaging; D012883:Skin Ulcer / Q000209:etiology*