Bone and soft tissue infections in patients with diabetic foot

Leone, Alessandro; Vitiello, Carmen; Gullì, Consolato; Sikora, Anna; Macagnino, Silvia; Colosimo, Cesare

doi:10.1007/s11547-019-01096-8

Cited by 11 publications

(28 citation statements)

References 48 publications

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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…Several secondary features such as subtending skin ulcer, sinus tract, abscess, tenosynovitis, or septic arthritis tend to be associated with OM. Their presence strongly suggests that osteomyelitis is present and can improve diagnostic accuracy [ 42 , 46 ]. Skin ulcer: Skin ulceration is typified by focal interruption of the cutaneous line, with raised margins (secondary to preexisting callus formation).…”

Section: Radiological Modalities For Imaging Dfimentioning

confidence: 99%

“…Acute ulcer appears hyperintense on fluid-sensitive fat-suppressed images, with marked peripheral post-contrast enhancement, which is a finding that is indicative of granulation tissue at the base of the ulcer. Chronic ulcer may be associated with fibrous healing and thus appears as a mass with low signal intensity on T1-weighted images and low to intermediate signal intensity on fluid-sensitive fat-suppressed images [ 42 , 43 , 46 ]. Sinus tract and abscess: Sinus tracts and abscesses are some of the major findings in osteomyelitis.…”

Section: Radiological Modalities For Imaging Dfimentioning

confidence: 99%

“…On MRI, it is characterized by an abnormal increase in fluid within the tendon sheath, and post-contrast images may show a thick rim enhancement around the tendon, due to inflamed synovium. The tendon loses its constant low signal intensity and becomes thickened and indistinct [42,43,46].…”

mentioning

confidence: 99%

“…Bones that "disappear" on T1-weighted images and then "reappear" on contrast-enhanced or T2-weighted images (the "ghost sign") is another MRI feature that indicates the presence of a superimposed infection. In uncomplicated neuropathic osteoarthropathy, the "ghost sign" is absent because there is bone destruction, but there is no infiltration of the marrow by inflammatory cells resulting in absence of the "ghost sign" [42,43,46]. Distinguishing OM from neuropathic osteoarthropathy, in the absence of secondary signs of infection, is a common and difficult clinical and radiological problem.…”

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confidence: 99%

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Diabetic Foot Infections: The Diagnostic Challenges

Lauri

Leone

Cavallini

et al. 2020

JCM

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Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients.

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Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Radiological Modalities For Imaging Dfimentioning

confidence: 99%

Section: Radiological Modalities For Imaging Dfimentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Diabetic Foot Infections: The Diagnostic Challenges

Lauri

Leone

Cavallini

et al. 2020

JCM

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Musculoskeletal infections through direct inoculation

Sabir,

Akkaya

2024

Skeletal Radiol

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Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings.

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Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses

et al. 2021

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Purpose No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses. Methods Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton’s neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes. Results Median VAS and FFI before treatment were 8[5–8.5] and 45.85[32.4–59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0–5] and 0 [0–2.75], respectively) and median FFI (7.9 [3.95–20] and 0 [0–3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton’s neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters. Conclusion Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.

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Bone and soft tissue infections in patients with diabetic foot

Cited by 11 publications

References 48 publications

Diabetic Foot Infections: The Diagnostic Challenges

Diabetic Foot Infections: The Diagnostic Challenges

Musculoskeletal infections through direct inoculation

Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses

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