Osteomyelitis in Foot and Ankle (OM)

What is osteomyelitis?

Osteomyelitis is an infection of the bone with progressive inflammatory destruction. 

What  causes osteomyelitis?

There are many ways a bone can develop an infection, but are mainly categorized into hematogenous (from the blood), contiguous spread (from the surrounding tissue), or direct inoculation ( bacteria being put on the bone). 

How to diagnose osteomyelitis?

Depending on the cause of osteomyelitis there are clinical questions that are asked such as recent blood infection (sepsis), current/past open wound from an ulcer or open fracture, surgical contamination, penetration with an object. X-rays can show cortical erosion of the infected bone which may take up 2 weeks to show and require at least 50% of bone loss to be evident on X-ray. Other signs on X-rays can be a sequestrum (a piece of dead bone), involucrum (formation of new bone around the dead bone), and cloaca ( channel for involucrum to drain). Advanced imaging is typically done MRI/CT to look for the extent of OM, on MRI we looked for increased signal intensity on the T2 and decreased signal intensity on T1. Labs are often drawn including blood culture, CMP, CBC, CRP, ESR, and possibly procalcitonin. The gold standard for diagnosing OM is bone biopsy 

How to treat osteomyelitis?

When a patient has OM they will be treated with oral/IV antibiotics pending culture results and typically surgical debridement of all non-viable and necrotic tissue needs to be done. There is a debate in the community on whether long term antibiotics can be used to treat OM or whether a patient must get surgery to be treated. If the Podiatric surgeon or Orthopedic surgeon is taking the patient to the OR for surgical debridement, it is important to remember to take a proximal margin to send to pathology to insure complete resection of infected tissue or need for prolonged IV antibiotics afterwards. See your local Podiatrist if you think you have osteomyelitis of your foot or ankle.

Foot and Ankle Surgery – Video of bone biopsy with jam shidi needle : https://www.youtube.com/watch?v=TQn8l88t3Yk

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