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Diabetic Foot Infections Differential Diagnoses

  • Author: Michael Stuart Bronze, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
Updated: Feb 23, 2016

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

Contributor Information and Disclosures

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

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

Disclosure: Nothing to disclose.


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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Romesh Khardori, MD, PhD, FACP Professor of Endocrinology, Director of Training Program, Division of Endocrinology, Diabetes and Metabolism, Strelitz Diabetes and Endocrine Disorders Institute, Department of Internal Medicine, Eastern Virginia Medical School

Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians, American Diabetes Association, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

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

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

  3. 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. 2005 Nov 12. 366(9498):1695-703. [Medline].

  4. 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. 2007 Aug. 60(2):370-6. [Medline]. [Full Text].

  5. 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. 2005 Feb. 55(2):240-5. [Medline]. [Full Text].

  6. 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. 2007 Oct. 60(4):819-23. [Medline]. [Full Text].

  7. 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. 2007 Aug. 19(4):410-6. [Medline].

  8. Morbach S, Furchert H, Gröblinghoff U, Hoffmeier H, Kersten K, Klauke GT, et al. Long-Term Prognosis of Diabetic Foot Patients and Their Limbs: Amputation and death over the course of a decade. Diabetes Care. 2012 Jul 18. [Medline].

  9. [Guideline] Hingorani A, LaMuraglia GM, Henke P, Meissner MH, Loretz L, Zinszer KM, et al. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg. 2016 Feb. 63 (2 Suppl):3S-21S. [Medline].

  10. Tucker ME. New guidelines stress need for diabetic foot ulcer offloading. Medscape Medical News. Available at Accessed: December 26, 2014.

  11. Snyder RJ, Frykberg RG, Rogers LC, Applewhite AJ, Bell D, Bohn G. The management of diabetic foot ulcers through optimal off-loading: building consensus guidelines and practical recommendations to improve outcomes. J Am Podiatr Med Assoc. 2014 Nov. 104(6):555-67. [Medline].

  12. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care. 2011 Sep. 34(9):2123-9. [Medline].

  13. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun. 54(12):e132-73. [Medline].

  14. Tucker M. Short-Course Antibiotics Good in Diabetic Foot Osteomyelitis. Medscape Medical News. Available at Accessed: November 27, 2014.

  15. Tone A, Nguyen S, Devemy F, Topolinski H, Valette M, Cazaubiel M, et al. Six- Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study. Diabetes Care. 2014 Nov 20. [Medline].

  16. 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 Accessed: July 27, 2011.

  17. Lázaro-Martínez J, Aragón-Sánchez J, García-Morales E. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis. A randomized comparative trial. Diabetes Care. 2013 Oct 15. [Medline].

  18. Nainggolan L. Antibiotics First Choice for Diabetic Foot Osteomyelitis. Available at Accessed: October 28, 2013.

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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