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March 1961

Bone Changes in Necrosis in Diabetes Mellitus: Differentiation of Neuropathic from Ischemic Necrosis

Author Affiliations


From the Department of Medicine, Woman's Medical College of Pennsylvania and the Department of Medicine, Albert Einstein Medical Center.

Arch Intern Med. 1961;107(3):380-383. doi:10.1001/archinte.1961.03620030068009

In managing patients with diabetes mellitus with soft-tissue necrosis of the feet, we have found the bone changes on x-ray to be a determining factor in preventing amputation in a number of these patients. Bone changes in the diabetic are most often the result of neuropathy and rarely caused by ischemia with osteomyelitis. It is not generally known that rarefaction, lysis, or destruction of bone will not occur in the foot of a patient with diabetes mellitus unless the circulation is adequate. These bone changes are not uncommonly attributed to ischemia with osteomyelitis because one or both pulses may be absent in the foot, despite other evidence of good blood flow. This is a dangerous situation for the diabetic patient with this clinical picture. The misinterpretation of bone changes in the feet of diabetic patients can easily lead to unnecessary amputation. The prognosis in a diabetic patient with a soft-tissue