Bone infections can be a very devastating problem. The usual cause of bone infection is an open wound in the skin. Diabetics who have a lack of sensation to their feet are especially at high risk of developing wounds and subsequent infection of the bones. Although anyone can technically develop a bone infection Diabetics have a suppressed immune system and therefore develop the infection more easily.
The skin is our main barrier to germs and bacteria from getting into our bodies. When our skin is compromised these bacterium can enter into the wound and infect the skin. The skin infection can extend deeper into the body and travel into the bone. The process can be slow but it can also be very rapid.
The gold standard in diagnosis osteomyelitis is a bone biopsy of the suspected infected bone. The bone sample is sent to a pathologist that will analyze the cells of the bone under a microscope. If inflammation and necrosis of the cells is seen then the diagnosis of osteomyelitis will be given. X-rays can show advanced stages of osteomyelitis by highlighting boney erosion where the infection is occurring. MRI is more specific and sensitive than X-ray and can be used to show the extent of the bone infection. A tri-phasic bone scan can also be used to determine boney infections. This scan utilizes radiopaque dye and X-ray imaging. The dye is introduced into the vein of the patient and X-rays are taken at specific times after the injection. If the image shows an area of dye in all 3 phases then osteomyelitis is most likely the diagnosis.
We treat bone infections with either oral or intravenous antibiotics. Oral antibiotics sometimes do not have the potency to achieve healing of the bone and therefore a six week course of IV antibiotics will be initiated. The IV antibiotics are very potent and can penetrate deep into the bone through the surrounding vessels. A follow bone culture after treatment can determine whether or not there is still any remaining infection. If the bone infection does not improve then surgical intervention is typically warranted. Cutting out the infected bone can eliminate the diseased bone immediately without having to utilize IV antibiotics. The surgeon will determine inter operatively what bone is healthy and what bone is diseased. The diseased bone is removed and the health bone is preserved. The MRI can also help to determine the extent of the diseased bone so that proper surgical planning can be achieved.
In podiatry it is our goal to preserve all limbs and amputation or removal of bone is the last resort when it comes to boney infections. Conservative measures are utilized if they will actually benefit the patient. The main defense against this type of infection is preventative measures. Not allowing the skin to break down is the most crucial step in fighting against osteomyelitis.