A Closer Look At Osteomyelitis

Osteomyelitis refers to a progressive bone tissue inflammation that is caused by infection either through haematogenous or contiguous bacterial inoculation.

This could affect only a part of a single bone section or multiple sections such as the periosteum, cortex or marrow; osteomyelitis could also involve more than one bone as in the case of a septic joint, infected prostheses or a Charcot neuroarthropathy-related infection.

Acute osteomyelitis, if left untreated for a significant period of time, can result in the formation of necrotic bone segments which contribute to continual or chronic infection ultimately causing chronic osteomyelitis.

As described by Marais et al., “osteomyelitis typically occurs in the setting of a large bacterial inoculation in combination with trauma, necrosis or ischaemia of tissue and/or the presence of foreign material”.

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Caitlin Garwood and Paul Kim state the lower extremity as the most susceptible to infection due to a number of factors such as thin soft tissue layers, poor vascular supply, neuropathy, structural deformity, boney prominences and poor fitting shoes.

The authors attribute the destructive appearance of the bone to osteoclastic activity stimulated by inflammatory factors such as interleukin-1 and tumour necrosis which cause loss of bone.

The lack of standardised tests and prevalence of nonspecific clinical signs and symptoms makes the diagnosis of osteomyelitis challenging, necessitating a combination of different modalities such as history, physical examination, laboratory values, imaging, microbiology and bone biopsies.

Depending on the severity and extent of the condition, management and treatment strategies would have to be individualised in order to eliminate infection and to prevent the development of chronic infection or recurrence.

MASS4D® customised foot orthotics should be introduced as a prophylactic measure especially for high-risk populations such as diabetic patients.

This is primarily because of complicating factors such as peripheral neuropathy, peripheral vascular disease and underlying immunocompromise increasing the incidences of foot ulcerations and infections.

The full-contact MASS4D® foot orthotics relieve pressure from the at-risk areas of the foot by distributing weight more evenly along the plantar surface of the foot; this allows the ulcer to heal whilst permitting the patient to remain ambulatory during treatment.

The special Bi-Lam cushion top cover helps patients suffering from insensate foot symptoms and protects against any unnoticed blistering or ulcerations.

The use of therapeutic shoes with pressure-relieving orthotics can help significantly reduce the development of diabetic foot ulcers by properly distributing weight along the plantar surface of the foot and maintaining joint range of motion.

With a reduction of ulcerations, there is limited bacterial exposure that helps in the prevention of osteomyelitis.

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Related Links
Managing Traumatic Foot Injury
Supportive Treatment for Diabetic Peripheral Neuropathy
Risk Factors for Foot Ulcerations

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References:

1. Boffeli, T. J. (2015) Osteomyelitis of the Foot and Ankle: Medical and Surgical Management. Springer International Publishing Switzerland.
2. Lima, A. L. L., Oliveira, P. R., Carvalho, V. C., Cimerman, S., Savio, E. (2014) Recommendations for the Treatment of Osteomyelitis. The Brazilian Journal of Infectious Disease: September 2014, Vol. 18, No. 5. DOI: 10.1016/j.bjid.2013.12.005
3. Marais, L. C., Ferreira, N., Aldous, C., le Roux, T. L. B. (2013) The Pathophysiology of Chronic Osteomyelitis. South African Orthopaedic Journal: 2013, Vol. 12, No. 4, pp. 14-18.

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