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No single feature of the history of physical examination reliably rules out ostemyelitis
Aids in making the diagnosis include:
An ulcer area larger than 2 cm2 (LR 7.2),
A positive probe to bone test (LR 6.4),
An ESR greater than 70 mm/h (LR 11)
References
Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA. 2008 Feb 20;299(7):806-13.