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When bone is probed in a diabetic ulcer, the likelihood of osteomyelitis being present is between 60-70%. Diabetic ulcers are the most common reason that diabetic patients seek medical treatment. If bone is exposed or can be palpated, there is a 67% chance of osteomyelitis being present. The osteomyelitis is usually polymicrobial in nature, with Staphylococcus aureus being the most common pathogen. The presence of ulceration is the most predictive factor for eventual amputation in diabetic patients. Lavery et al. measured the accuracy of the probe-to-bone (PTB) test to diagnose osteomyelitis. They found that the PTB test had a positive predictive value of 57%, the sensitivity and specificity being higher. Grayson et al. evaluated foot ulcers to identify the presence of osteomyelitis. When osteomyelitis was diagnosed in 50 cases, bone was probed in 66% of these cases. They concluded that probing to bone was strongly correlated with the presence of osteomyelitis. If bone is palpated, the additional confirmatory tests are unnecessary. Pinzur et al. provide guidelines for management of diabetic feet. They note that the screening examination should include evaluation for neuropathy, the presence of ulcers or wounds and vasculopathy. Ulcers should be treated with debridement as necessary, dressings and off-loading. Figure A shows a plantar diabetic ulcer adjacent to the second metatarsal. Incorrect Answers Answers 1, 2, 3, 5: The probe-to-bone test demonstrates a likelihood of osteomyelitis of close to 70%.
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