A diabetic client came in to us concerned that he might lose his toe. It was an unusual case which prompted this article. Osteomyelitis is infection in the bone. It can occur in infants, children, and adults. Different types of bacteria typically affect the various age groups. In children, it is most common at the ends of the long bones of the arms and legs, affecting the hips, knees, shoulders, and wrists. Adults experience it more in the bones of the spine (vertebrae), feet, or in the pelvis.
What causes it?
This infection can develop in several different ways, via:
• Bacteremia — which is bacteria travelling through the bloodstream and spreading to the bone. It tends to be prevalent when the patient has an infection elsewhere in the body — such as pneumonia or a urinary tract infection that spreads through the blood to the bone.
• An open wound over a bone — and happens most commonly with underlying peripheral vascular disease, peripheral neuropathy, or diabetes. With an open fracture (compound fracture), the bone that punctures through the skin is exposed to bacteria. This increases the risk factor. Also, recent surgery or injection around a bone can also expose the bone to bacteria and lead to it.
• A weakened immune system — patients with conditions or taking medications that weaken their immune system are more susceptible. Risk factors include cancer, chronic steroid use, sickle cell disease, human immunodeficiency virus (HIV), diabetes, haemodialysis, intravenous drug users, and the elderly.
Symptoms can vary greatly and tend to present more quickly in children. They develop pain or tenderness over the affected bone, and may have difficulty or are unable to use the affected limb, bear weight, or walk, due to severe pain. They may also have fever, chills, and redness at the site of infection.
In adults, the symptoms often develop more gradually and include fever, chills, irritability, swelling or redness over the affected bone, stiffness, and nausea. In people with diabetes, peripheral neuropathy, or peripheral vascular disease, there may be no pain or fever. The only symptom may be an area of skin breakdown that is worsening or not healing.
Acute osteomyelitis comes with a rapid onset, and is usually accompanied by the symptoms of pain, fever, and stiffness. It generally occurs after a break in the skin from injury, trauma, surgery, or skin ulceration from wounds.
Chronic osteomyelitis is insidious (slow) in onset. It may be the result of a previous infection of the condition. Despite multiple courses of antibiotics, it may reoccur. Symptoms are subtle, but may include fever, pain, redness, or discharge at the site of infection.
How is it diagnosed?
The diagnosis begins with a complete medical history and physical examination. During the medical history, the doctor may ask questions about recent infections elsewhere in the body, past medical history, medication usage, and family medical history.
The physical examination will incorporate checking for areas of tenderness, redness, swelling, decreased or painful range of motion, and open sores.
The doctor may then order tests to help with the diagnosis. Several blood tests can be used to help determine if there is an infection present. These include a complete blood count (CBC), the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood cultures. None of these is specific for osteomyelitis, but they can suggest that there may be some infection in the body.
Imaging studies may be obtained of the involved bones. These can include plain radiographs (X-rays), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRIs), and ultrasounds. These imaging studies can help identify changes in the bones that are the result of the condition.
After an area of bone is identified with possible osteomyelitis, a biopsy of the bone may be obtained to help determine precisely which bacteria are involved.
In many cases, antibiotics and pain medications are effective. If a biopsy is obtained, this can help guide the choice of the best antibiotic. The duration of the treatment with antibiotics is usually four to eight weeks, but varies with the type of infection, and the patient's response. In some cases, the affected area will be immobilised with a brace, to reduce the pain and speed up the treatment.
Sometimes, surgery may be necessary. If there is an area of localised bacteria (abscess), this may need to be opened, washed out, and drained. If there is damaged soft tissue or bone, this may have to be removed. If it is necessary to remove bone, it may have to be replaced with a bone graft or stabilised during surgery.
What is the prognosis
With early diagnosis and appropriate treatment, the prognosis is good. Antibiotics regimes are used for four to eight weeks and sometimes longer, depending on the bacteria that caused it, and the patient's response. Usually patients can make a full recovery without longstanding complications.
However, if there is a long delay in diagnosis or treatment, there can be severe damage to the bone or surrounding soft tissues, making the patient more prone to reoccurrence. If surgery or bone grafting is needed, this will prolong the time it takes to recover.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner
attached to ALMAWI Limited – The Holistic Clinic. Call 662-1732 for an appointment, or email firstname.lastname@example.org Tuesday - Saturday. Check for the Clinic at www.almawiclinic.com.