Management of Deep Ulceration / Osteomyelitis

Approximately 20% of patients with neuropathic ulceration and 11% of patients with neuro-ischaemic ulceration go on to develop osteomyelitis, despite appropriate antibiotic therapy

  1. Suspect clinically if "Sausage Toe" deformity
  2. Refer to Specialist Podiatry Service if suspected
  3. May be diagnosed by X-ray, but radiological changes take up to 3 weeks to develop
  4. Triple phase bone scan and MRI scans are more useful.
  5. Clindamycin 300mg qds and Ciprofloxacin 750mg bd are optimum choices; use for at least six weeks.

Management of Non-Healing Ulcers/ Recurrent Ulceration

  1. Refer to Specialist Podiatry Service if suspected
  2. Consider vascular investigations for patients with non-healing ulcers and absent peripheral pulses
  3. Ankle Brachial Pressure Index (ABPI), using Doppler, interpret with care in patients with diabetes, due to vessel calcification
  4. Absolute pressures of 50mmHg at the ankle may be indicative of significant arterial disease
  5. If pressure measurements are suggestive of arterial disease, then Doppler, standard angiography or MRI angiography should be requested, with a view to revascularisation for suitable lesions

ULCER FLOW CHART

Ulcer Flow Chart

 

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