• Osteomyelitis should be suspected when a sterile probe, inserted into the base of an ulcer, penetrates to bone. Usually osteomyelitis will present in association with soft tissue infection. Occasionally it may present as probing to bone in an apparently clean, non-infected ulcer

• It may present as obvious fragmentation of the bone within the ulcer bed which is easily visible

• It is most commonly diagnosed on X-ray (Fig. 5.1 la,b). Loss of cortex, fragmentation and bony destruction on X-ray are signs of osteomyelitis

• Chronic osteomyelitis of a toe has a swollen, red, sausage-like appearance (Fig. 5.12).

Rarely, we have seen metastatic infection from a primary infection in the foot.

Fig. 5.12 'Sausage toe' with ulceration and cellulitis indicates osteomyelitis.

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