New research explores the prevalence and outcomes of the diabetic sausage toe

Researchers have published the first study to document the sausage toe as a prevalent presentation of diabetic toe infection.

The study set out to document the prevalence, presentation, treatment modalities and outcomes of the diabetic sausage toe, due to the fact that sausage toe as a diabetic osteomyelitis (OM) presentation is “very rarely investigated”.

The researchers, from Lebanese American University Medical Center-Rizk Hospital, say their findings demonstrate that it could be beneficial to include this entity in the diabetic wound classification systems.

They carried out a retrospective study of patients presenting a sausage toe on admission.

Several methods were used to diagnose OM, with two groups compared: acute and chronic sausage toes.

Three treatment modalities were applied and outcomes were defined as sausage toe prevalence, ulcer location, OM prevalence, and comparative treatment results.

The research team reported the following: “Out of 82 diabetic toe infection cases, 24 (30%) presented as ‘sausage toe’.

“The side of the proximal interphalangeal joint of the lateral toes was the most frequent ulcer location (50%), mostly on the dorsal aspect followed by the side aspect.

“There were 15 (62.5%) acute cases and 9 (37.5%) chronic cases. MRI showed signs of OM in 21 (87.5%) cases and signs of septic arthritis in 3 (12.5%) cases.”

At follow-up, a successful treatment was recorded in five (20%) cases with antibiotics alone. Out of the 19 (42%) procedures, conservative surgery was performed successfully in eight (58%) cases while amputation was carried out in 11 (45.8%) cases. There was no significant difference in amputation frequency between acute and chronic groups.

The study authors said: “The sausage toe as a presentation of diabetic foot infection is a prevalent condition.

“The deformity is conclusive of deep infection with a very high osteomyelitis frequency. Surgery is often required for infection control and healing, mainly for chronic cases, and treatment outcomes did not differ between acute and chronic sausage toe groups.”

Read the study, The diabetic sausage toe: Prevalence, presentation and outcomes, here.