Complications of diabetes mellitus commonly affect the foot, with potentially disastrous consequences. Foot complications in diabetic patients account for more hospital days than any other aspect of the disease. Amputation is the most feared complication of diabetic foot disease, with 40 to 70% of non-traumatic amputations performed on diabetic patients.1
Diabetic foot disease can be divided into three main categories – infectious, neuropathic, and vascular diseases – plus miscellaneous maladies, such as spontaneous tendon rupture. This article will focus primarily on the first two, infectious and neuropathic foot disease.
♦ Infectious Foot Disease
Foot infections are classified primarily according to the site of involvement. The infection may be osseous (osteomyelitis), articular (septic arthritis), bursal (septic bursitis), subcutaneous (cellulitis or abscess), muscular (infectious myositis), or tendinous (infectious tenosynovitis). In addition, infectious processes such as osteomyelitis can be characterized as acute, subacute, or chronic. Although most serious foot infections are bacterial, on rare occasions fungi, parasites, or viruses may be the responsible pathogens.
• Causes The vast majority of cases of osteomyelitis affecting the diabetic foot are the result of contiguous…
• Preventive Care Because skin ulceration is the first step toward the development of osteomyelitis in most diabetic patients, preventive foot care is…
• Amputations Approximately 60% of all non-traumatic lower extremity amputations are performed in the ….
• Clinical Diagnosis of osteomyelitis is notoriously difficult. On physical examination, fever is….
♦ Neuropathic Osteoarthropathy
Neuropathic osteoarthropathy arises when repetitive micro- or macrotrauma occurs in the setting of diminished proprioception and pain sensation. Local ligamentous injury and hyperemia may result in…
Diabetic neuropathic osteoarthropathy typically appears in patients…
Pathologically, the early stages of cartilage erosion and osteophytosis may simulate…
MRI – Clinical Experience
• Standard MRI MRI is highly sensitive in determining the presence and the extent of inflammation – two cardinal objectives in any preoperative evaluation. MRI can help delineate whether an infection is limited to bones, joints, or…
• Contrast-enhanced MRI The diagnosis of osteomyelitis on MRI is made by detecting changes in signal intensity (brightness) and contrast enhancement in the bone marrow after intravenous…
Discussion: MRI vs Alternative Imaging Methods
• Radiographs are also useful for correlation with MRI to document the presence of fractures and neuropathic…
• CT can be a useful method to detect early osseous erosion, as well as to document the presence of a sequestrum, foreign body, subcutaneous…
• Nuclear medicine scans, especially technetium-99m methylene diphosphonate bone scintigraphy…
• White blood cells labeled with radioactive tracers can be used to increase the specificity over that of three phase…
• Contrast-enhanced MRI as the preoperative imaging modality may actually lower the total…
Conclusion
This article was edited from MR Imaging of the Diabetic Foot by the same author. The unabridged version, as well as all of its images and references, is available at the Apple iBooks Store – get it today! Check out all our other great books here.
REFERENCES
- Hinkes M. Foot health and amputation prevention for the long-term care resident. Published online March 24, 2009.
- Fridman R, Bar-David T, Kamen S, et al. Imaging of diabetic foot infections. Clin Podiatr Med Surg. 2014 Jan;31(1):43-56.
