Percutaneous Partial Bone Excision in the Management of Diabetic Toe Osteomyelitis

BACKGROUND

Diabetic foot osteomyelitis affecting the toes is associated with several complications including amputation. Management is variable and include medical therapy alone or coupled with surgery. Removal of infected tissues is a common therapeutic option. However, limited source data are available. This study determines the outcome and complications of percutaneous partial bone excision (PPBE) of infected bone among diabetic patients with toe osteomyelitis.

METHODS

This is an uncontrolled experimental prospective study in diabetic patients who underwent PPBE of infected pieces of bone for toe osteomyelitis in the outpatient setting at a single foot clinic. All participants were followed up until the occurrence of wound healing or amputation.

RESULTS

Forty-seven patients (mean ± SD age was 62.8 ± 11.6 years) participated. Forty-four patients (93.6%) had complete healing and 3 (6.4%) required toe amputation. The mean (±SD) wound healing time was 11 (±4.6) (range, 7-22) weeks. Diabetes mellitus type 1 and younger age were significantly associated with increased risk for amputation.

CONCLUSION

PPBE of infected toes in diabetic patients can be performed successfully and safely in the outpatient clinic. It can also improve healing and avoids inpatient stay.

LEVEL OF EVIDENCE

Level II, prospective cohort study.

Peripheral arterial disease in diabetic Jordanian patients and the agreement between ankle brachial index and toe brachial index

This study aims to screen patients with type 2 diabetes mellitus for peripheral arterial disease (PAD) and to determine the agreement between ankle brachial index (ABI) and toe brachial index (TBI). A total of 182 diabetic patients at 40 years of age or older were assessed using both ABI and TBI. Mean age was 60.5 (SD ±8.1) years. PAD was present in 28.9% and 5.4% of patients according to TBI and ABI definitions respectively. The prevalence of high ABI (ABI > 1.3) was 16.5%. The agreement between TBI and ABI results was fair. Current smoking was associated with low ABI whereas age was inversely associated with TBI. We strongly suggest using both the ABI and TBI as screening tests for PAD because the agreement between these tests was fair, they complement each other in most instances and they detect PAD at different anatomical levels.