Sausage toe: an upsetting symptom in diabetic patients

Abstract

With diabetes reaching almost epidemic proportions, foot problems have become increasingly prevalent worldwide, resulting in major economic consequences for both diabetic patients and society. Although some detailed studies regarding this condition are present in the existing literature, no clear consensus has been established regarding the diagnosis and treatment of diabetic foot infection and osteomyelitis. Thus, any sign that may be used to predict osteomyelitis of the foot in diabetic patients is valuable. We believe that the presence of a “sausage toe” could be a reliable sign of osteomyelitis. This cohort study was carried out at the Chronic Wound Clinic of a major institute over a period of 3 years. All diabetic patients who had a sausage toe were identified and followed up prospectively. A swollen toe that had lost its normal contours and resembled a sausage was defined as a sausage toe. All 16 patients included in this study had type II diabetes (min 5-year duration). The mean HbA_1c level among the patients was 9.28% (4–5.6% nondiabetic range). All patients had reduced pinprick and vibration sensation but good peripheral pulsation in their affected foot. Overall, six patients were diagnosed with underlying bone infections. Additionally, six patients received hyperbaric oxygen therapy and a total of ten patients required surgical intervention. Four patients required surgical debridement of ulcers that developed during the follow-up. Five patients who were diagnosed with osteomyelitis required local amputations. Complete resolution of six sausage toes was achieved using nonsurgical treatment modalities. The definition of a sausage toe is rather subjective. Although its definition has relatively low specificity, a sausage toe is an easily identifiable and cost-free clinical sign that can be used as an indicator of underlying bone infection.