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September 20, 1995

Probing to Bone in Infected Pedal Ulcers-Reply

Author Affiliations

New England Deaconess Hospital Boston, Mass

JAMA. 1995;274(11):869-870. doi:10.1001/jama.1995.03530110031017

In Reply.  —We thank Dr Nardone for his careful reading of our article and his thought-provoking comments.There are, as noted, limitations (practical and ethical) to the tests to which diabetic patients can be subjected in order to ascertain the presence or absence of pedal osteomyelitis. Nevertheless, in evaluating the probe test, the issue is not having a single criterion standard, but rather knowing the true state of the patients regarding osteomyelitis. A histologic diagnosis of osteomyelitis is definitive. Ruling out osteomyelitis by histology, unless one has a large bone sample (as was the case in 11 [seven early, four delayed] of our osteomyelitis-negative cases), is difficult because of the significant risk for sampling error. Prolonged follow-up without recurrence of an infected ulcer in the absence of therapy for osteomyelitis is as definitive as any other test to rule out osteomyelitis in this population. Additionally, we included other available information

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