Because osteomyelitis can arise without evidence of soft tissue infection due to neuropathy (diminished pain) and poor peripheral blood flow (diminished erythema, warmth, and purulence). Therefore, foot imaging (eg, x-ray, MRI) is generally recommended for all diabetic foot ulcers that are:
• deep (eg, exposed bone, positive probe-to-bone testing).
• long-standing (eg, present >7-14 days).
• large (eg, ≥2 cm).
• associated with elevated erythrocyte sedimentation rate/C-reactive protein.
• associated with adjacent soft tissue infection.
Mnemonic : pay bill for imaging!
“BILL” - Bone , Inflammation/infection , Large , Long standing
That’s all!
Thank you!
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