Critical appraisal of ‘The Diabetic Sausage Toe: Prevalence, Presentation and Outcomes’

Abstract

We read the article titled ‘The Diabetic Sausage Toe: Prevalence, Presentation, and Outcomes’ by Yammine et al.¹ with great interest. This study represents an important contribution to understanding diabetic foot infections by exploring the under-recognized condition of ‘sausage toe’, a unique manifestation of diabetic osteomyelitis (OM). Given the study's focus on prevalence and treatment outcomes, its findings provide a valuable basis for improving diabetic wound classification systems and clinical management. However, we believe that addressing certain methodological limitations could enhance the study's robustness and applicability.

First, while the study provided insightful results, it omitted key laboratory parameters that could have offered a deeper understanding of disease severity and outcomes. Biomarkers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) are valuable indicators of inflammatory response and infection activity.^{2, 3} Including these markers would have contributed to a more comprehensive analysis of disease progression and therapeutic effectiveness.

Second, the study needed more details on antibiotic regimens, such as the types of antibiotics administered, their duration and other medications used. This information is particularly pertinent as multidrug-resistant organisms (MDROs) are known to complicate treatment outcomes in diabetic foot ulcers (DFUs).⁴ Culture results and the specific types of microorganisms involved should also have been reported, as they are essential for tailoring treatment plans.

Moreover, while the authors documented treatment outcomes, they did not consider comorbidities like nephropathy, retinopathy and cardiovascular disease, which are prevalent in diabetic patients and can significantly affect recovery.⁵ Analysing the impact of these conditions on sausage toe outcomes would have strengthened the study's conclusions regarding prognosis and individualized care.

Lastly, patient lifestyle factors, such as smoking, alcohol consumption and histories of invasive procedures (e.g., amputations or revascularizations), were not addressed. Including these factors could have shed light on their potential influence on the severity of the condition and the differential outcomes between acute and chronic cases.

In conclusion, Yammine et al. have made a significant contribution by identifying the prevalence and presentation of diabetic sausage toe. However, addressing the outlined limitations could improve the generalizability and clinical impact of their findings. We believe that incorporating these considerations in future studies will further advance the understanding and treatment of this critical condition.

The authors declare no conflicts of interest.