Core IM | Internal Medicine Podcast #204 Diabetic Foot Infections & Osteomyelitis: 5 Pearls Segment
Apr 1, 2026
Clear steps to spot hidden diabetic foot infections and when a probe-to-bone test matters. Practical imaging and biopsy tips to avoid overcalling osteomyelitis. When surgery is needed versus antibiotics and why oral therapy can be as effective as IV. Simple, usable wound care and offloading strategies for everyday clinical practice.
AI Snips
Chapters
Transcript
Episode notes
Probe To Bone To Rule In Osteomyelitis
- Use the probe-to-bone test as a high-value bedside tool to evaluate for osteomyelitis and increase diagnostic certainty.
- Gently probe ulcer base and periphery to assess depth, tendon or bone involvement, and sinus tracts; a positive probe-to-bone strongly suggests osteomyelitis.
MRI Is Sensitive But Can Overcall Osteomyelitis
- Plain films are a good first-line imaging test and MRI is sensitive but not perfectly specific for osteomyelitis.
- MRI often shows bone marrow edema which is nonspecific and can reflect pressure injury, risking overdiagnosis if relied on alone.
Check Perfusion Before Expecting Healing
- Always assess and optimize blood flow before expecting wounds to heal or antibiotics to penetrate; get an ABI when PAD is suspected.
- If vascular compromise is present, involve vascular surgery for revascularization because poor perfusion prevents healing and drug delivery.