05 June 2026
Osteomyelitis is a complex and frequently less recognised complication of pressure ulcers, particularly those associated with deep tissue loss and exposed bone. For community nurses, early recognition is challenging because clinical presentation is often subtle, diagnostic certainty is limited in the early stages, and the evidence base specific to pressure ulcers above the ankle remains underdeveloped. This first article in a two-part series focuses on the clinical foundations required for early identification, integrating epidemiology, pathophysiology, and key risk factors, alongside a structured and holistic approach to history-taking and clinical examination. It emphasises the role of community nurses as first assessors, highlighting the importance of recognising high-risk presentations such as category 4 pressure ulcers, exposed or palpable bone, delayed healing, and recurrent local inflammation. By strengthening clinical suspicion and supporting timely escalation, this article aims to improve early recognition and reduce missed or delayed diagnosis of osteomyelitis in primary and community care.
