Features characteristic of diabetes‐related osteomyelitis of the foot on plain x‐rays

New or evollistaving radiographic features^* on serial radiographs,^¶ including:

Loss of bone cortex, with bony erosion or demineralisation
Focal loss of trlistaabecular pattern or marrow radiolucency (demineralisation)
Periosteal reaction or elevation

Bone sclerosis, with or without erosion

Abnormal soft tissue density in the subcutaneous fat, or gas density, extending from skin towards underlying bone, suggesting a deep ulcer or sinus tract

Presence of sequestruma: devitalised bone with radiodense appearance separated from normal bone

Presence of involucrum^*: layer of new bone growth outside previously existing bone resulting, and originating, from stripping off the periosteum

Presence of cloacae^*: opening in the involucrum or cortex through which sequestrum or granulation tissue may discharge

* Some features (eg, sequestrum, involucrum, and cloacae) are seen less frequently in diabetes‐related foot osteomyelitis than in younger patients with osteomyelitis of larger bones.

¶ Usually spaced several weeks apart.

From: Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev 2024; 40:e3687. Copyright © The Authors. https://onlinelibrary.wiley.com/doi/10.1002/dmrr.3687 (Accessed April 26, 2024). Reproduced under the terms of the Creative Commons Attribution License 4.0.

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Features characteristic of diabetes‐related osteomyelitis of the foot on plain x‐rays