Diabetic Foot Infections Differential Diagnoses

  • Author: Michael Stuart Bronze, MD; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Jul 27, 2011
 
 

Diagnostic Considerations

Skeletal and soft-tissue infections of the foot are not limited to individuals with diabetes; therefore, other conditions may need to be considered in the differential diagnosis, depending on the infection and structures affected.

In cellulitis, differential diagnosis includes leukoclastic angitis, diabetic dermopathy, chronic venostatic change, and superficial thrombophlebitis.

Differential diagnosis in deep skin and soft-tissue infections includes gas gangrene, synergistic gangrene, Vibrio vulnificus infection, and Aeromonas hydrophilia infection.

Differentials in acute osteomyelitis include sickle cell crisis, Lyme arthritis, sarcoid arthritis, blunt bone trauma, and bone tumor.

In chronic osteomyelitis, differential diagnosis includes squamous cell carcinoma, bone tumor, and neuropathic joint.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Coauthor(s)

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Charles S Levy, MD  Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Lipsky BA, Armstrong DG, Citron DM, Tice AD, Morgenstern DE, Abramson MA. Ertapenem versus piperacillin/tazobactam for diabetic foot infections (SIDESTEP): prospective, randomised, controlled, double-blinded, multicentre trial. Lancet. Nov 12 2005;366(9498):1695-703. [Medline].

  2. Lipsky BA, Giordano P, Choudhri S, Song J. Treating diabetic foot infections with sequential intravenous to oral moxifloxacin compared with piperacillin-tazobactam/amoxicillin-clavulanate. J Antimicrob Chemother. Aug 2007;60(2):370-6. [Medline]. [Full Text].

  3. Lipsky BA, Stoutenburgh U. Daptomycin for treating infected diabetic foot ulcers: evidence from a randomized, controlled trial comparing daptomycin with vancomycin or semi-synthetic penicillins for complicated skin and skin-structure infections. J Antimicrob Chemother. Feb 2005;55(2):240-5. [Medline]. [Full Text].

  4. Stein GE, Schooley S, Peloquin CA, Missavage A, Havlichek DH. Linezolid tissue penetration and serum activity against strains of methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility in diabetic patients with foot infections. J Antimicrob Chemother. Oct 2007;60(4):819-23. [Medline]. [Full Text].

  5. Wang S, Cunha BA, Hamid NS, Amato BM, Feuerman M, Malone B. Metronidazole single versus multiple daily dosing in serious intraabdominal/pelvic and diabetic foot infections. J Chemother. Aug 2007;19(4):410-6. [Medline].

  6. Malabu UH, Al-Rubeaan KA, Al-Derewish M. Diabetic foot osteomyelitis: usefulness of erythrocyte sedimentation rate in its diagnosis. West Afr J Med. Apr-Jun 2007;26(2):113-6. [Medline].

  7. Tan PL, Teh J. MRI of the diabetic foot: differentiation of infection from neuropathic change. Br J Radiol. Nov 2007;80(959):939-48. [Medline]. [Full Text].

  8. US Food and Drug Administration. FDA Drug Safety Communication: Serious CNS reactions possible when linezolid (Zyvox®) is given to patients taking certain psychiatric medications. Available at http://www.fda.gov/Drugs/DrugSafety/ucm265305.htm. Accessed July 27, 2011.

 
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Chronic diabetic ulceration with underlying osteomyelitis. Plain film radiograph exhibiting cortical disruption at the medial aspect of the first MTP joint.
 
 
 
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