1. To understand the importance of X-ray in the surveillance of diabetic foot ulcers 2. To appreciate how certain dressings may obscure the view of the bone in an X-ray 3. To consider the removal of all dressings prior to X-ray removal for more accurate reporting of complications

Patients with diabetes mellitus have a high incidence of bone pathology, particularly when there are cutaneous ulcers present. In one of the first case series of diabetic foot ulcers, 77% of patients with ulceration of the foot had multiple bone lesions, even where there was not communication between the bone and the cutaneous ulcer and these lesions were not limited to the area of the ulcer. 1 Osteomyelitis, an inflammatory process of infectious nature, is an important complication causing bone lesions in such patients secondary...

There were 15 dressings altogether in the study. A skeletal hand (real bone) was placed on a clinical glove filled with water to mimic soft tissue density. Photographs were taken of each dressing overlying the hand as well of X-ray images taken of each to demonstrate the degree of interference the presence of a particular dressing can have on assessing the presence of osteomyelitis. Photographs and images are labelled as shown. Figure 1 details the different dressing types and their descriptions. Each one was given...

There is very little, if at all, in the literature about artefact caused by dressings on X-ray and its significance, except in the education of radiographers, where key texts reccommend removal of dressings.8Many instruction leaflets for silver containing dressings advise a patient to remove these prior to MRI for safety reasons,9 but this fear has been allayed in a recent study stating this isnot necessary.10 Dressings containing silver compounds particularly seem to obscure X-ray imaging in our study and this has implications for clinical practice....

1. Friedman SA, Rakow RB. Osseous lesions of the foot in diabetic neuropathy. Diabetes. 1971 May;20(5):302–7. 2. Brower AC. What is the preferred method for diagnosing osteomyelitis in the foot of a patient with diabetes? AJR Am J Roentgenol. 1994 Aug;163(2):471–2. 3. Bonham P. A critical review of the literature: part I: diagnosing osteomyelitis in patients with diabetes and foot ulcers. J Wound Ostomy Continence Nurs. 2001 Mar;28(2):73–88. 4. Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test...

Acknowledgements: Mr Phil Smalley, Senior Radiographer, SRFT for his advice and assistance in developing the "bone/glove" model and obtaining the radiographic exposures.