Osteomyelitis And Heel Ulcers: What You Should Know

Eric J. Lullove, DPM, CWS

   Magnetic resonance imaging is the imaging modality of choice for patients with osteomyelitis of the calcaneus. There is altered intensity of the affected bone. The MRI captures soft tissue infections, which makes it helpful to distinguish sensitivity. Researchers report MRI to be 90 to 100 percent sensitive for osteomyelitis while the specificity ranges between 80 to 100 percent.11 The normal high signal intensity of T1 images is replaced with decreased signal intensity and T2 images, which are dark normally, show increased signal intensities.12

What You Should Know About Non-Invasive Treatments

The underlying treatment principle with non-surgical treatment is to provide an environment where antibiosis can work effectively. Unfortunately, no antibiotic has proven to be superior in the complete eradication of osteomyelitis infections.13 In treating osteomyelitis of the heel non-surgically, it is imperative to cover for Staphylococcus due to its high incidence and prevalence.14 There is no preferred route as research has shown neither parenteral nor oral to be more effective than the other.13,14

   Classically, clinicians provide four to six weeks of parenteral therapy with concomitant serial debridements to remove the infected bone. It is of course reasonable to have a shorter duration of treatment with parenteral therapy and a longer duration with oral therapy.14 Additionally, there is no current substantial scientific evidence that gives a consistently predictable result with medical, parenteral or oral therapy for the treatment of osteomyelitis.15

   Hyperbaric oxygen therapy (HBOT) can be a useful adjunct in the non-operative management of osteomyelitis as well as improving post-surgical outcomes. Hyperbaric oxygen therapy helps fight this disease in the following three ways.

• HBOT helps strengthen the osteoclasts that reabsorb dead bone, allowing the osteoclasts to remove bony debris more effectively.
• HBOT enhances the function of the immune system’s white blood cells, which depend on oxygen. For this reason, HBOT is especially effective when one uses it with antibiotics as it supports the action of the antibiotics.
• HBOT helps the body create new capillaries.16

   As a result of these three factors, the body is able to get rid of the diseased bone and replace it with healthy bone.

   Oxygen is important in wound healing. When the environment of the fibroblast cell has an oxygen tension of less than 10 mmHg, the cell can divide but it can no longer make collagen. It also cannot migrate to where it is needed for healing. When the oxygen tension increases, the fibroblast can again carry out these wound healing functions. The collagen produced by these cells forms a fibrous matrix and new capillaries grow into this. Wound healing is a dynamic process and an adequate oxygen tension is mandatory for this process to proceed to healing. Hyperbaric oxygen provides oxygen to promote collagen production, angiogenesis and wound healing in the ischemic or infected wound. An adequate supply of oxygen is integral in the treatment of osteomyelitis.17

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