Diagnostic and prognostic value of erythrocyte sedimentation rate in contiguous osteomyelitis of the foot and ankle.

This is a 95-patient prospective study evaluating diagnostic and prognostic efficacy of erythrocyte sedimentation rate (ESR) for contiguous pedal osteomyelitis. ESRs, bone and soft tissue microbiologic cultures, and pathologic examination of the suspected bone involved were obtained. ESRs were drawn within 48 hours before surgically obtaining the bone specimen. A subset of 16 patients, determined by pathology to have osteomyelitis, had intermittent erythrocyte sedimentation rates drawn for at least 56 days to determine trends based on the patient being healed or not healed. Pathology resulted in diagnosis of osteomyelitis in 66 patients. A statistical significance of ESR was found when comparing those with and without osteomyelitis. Seventy-four had a secondary diagnosis of diabetes mellitus. No statistical significance was found in regards to ESR in absence or presence of osteomyelitis when considering the variable of diabetes mellitus. Negative and positive predictive values were calculated at different ESR levels to determine the diagnostic value of ESR. Eight patients with osteomyelitis, determined to be healed over 56 days of treatment, showed a decline of ESRs. No trend of declination was seen in 8 patients determined not healed after 56 days. A statistically significant difference in average ESR between patients with osteomyelitis who had no bacterial growth of bone and those with one or more organisms growing in bone was found. ESR as a diagnostic tool for contiguous pedal osteomyelitis has been found in this study to be both valuable and significant. The comorbidity of diabetes mellitus did not significantly change the ESR values in patients with or without osteomyelitis. ESR as a modality to document the success of treatment for those with osteomyelitis proved valuable in the subset of patients who were followed up.