Probing to Bone in Infected Pedal Ulcers

TLDR

The study evaluates a bedside probing technique to diagnose osteomyelitis in infected pedal ulcers. Prospectively, 75 diabetic patients with 76 infected foot ulcers were examined by probing with a sterile blunt stainless‑steel probe, and the presence of bone was compared to histopathologic or clinical osteomyelitis diagnoses. Bone palpation on probing was present in 66% of osteomyelitis cases and 15% of non‑osteomyelitis cases, yielding 85% specificity, 89% PPV, and 56% NPV, indicating a strong correlation and suggesting imaging can be omitted when bone is detected.

Abstract

To assess a bedside technique for diagnosing osteomyelitis.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.A tertiary care center.Seventy-five hospitalized diabetic patients with a total of 76 infected foot ulcers were studied.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%.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.