Original Article: Complications Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging

Aims To assess efficacy of conservative management of neuropathic forefoot ulcers with underlying osteomyelitis in subjects withdiabeteswhenmagneticresonanceimaging(MRI)isusedtoconfirmorestablishdiagnosisandtoguideantibioticduration. Methods A retrospective cohort study over 6 years assessing rates of ulcer healing, relapse and amputation. Antibiotics were continued for 3-month cycles with interval MRI: if the lesion had healed and bone signal change resolved or improved, antibiotics were discontinued; if the lesion had not healed or there was no difference in bone signal change, antibiotics were continued for a further 3-month cycle; clinical or radiological deterioration resulted in endoluminal or open vascular surgical intervention where appropriate, or digital or more proximal amputation. Results There were 53 episodes in 47 subjects (mean sd age 62 13 years, duration of diabetes 19 13 years, glycated haemoglobin 8.4 1.6%; six with Type 1 diabetes and seven with end-stage renal failure). Successful healing without relapse was achieved in 40 episodes (75%) [median (range) duration of antibiotics 6 (3‐12) months and follow-up post-cessation of antibiotics 15 (3‐58) months]. Relapse occurred in six episodes (13%) at 31 (2‐38) months post-cessation of antibiotics. There were one major (2%) and eight minor (15%) amputations. Five subjects have died (11%), all without foot ulcers. Conclusions High rates of healing and low rates of amputation were achieved. The use of MRI was associated with long courses of antibiotics, but particularly low relapse rate.