Jeffcoate, WJ and BA Lipsky. :Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. .Clin Infect Dis 39 ( suppl 2:):S115. ,2004. .
Lipsky, BA, AR Berendt, HG Deery, et al. :Diagnosis and treatment of diabetic foot infections. .Clin Infect Dis 39::885. ,2004. .
Frykberg, RG, B Wittmayer, and T Zgonis. :Surgical management of diabetic foot infections and osteomyelitis. .Clin Podiatr Med Surg 24::469. ,2007. .
van Baal, JG . :Surgical treatment of the infected diabetic foot. .Clin Infect Dis 39 ( suppl 2:):S123. ,2004. .
Lazzarini, L, BA Lipsky, and JT Mader. :Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 9::127. ,2005. .
Berendt, AR, EJ Peters, K Bakker, et al. :Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. .Diabetes Metab Res Rev 24 ( suppl 1:):S145. ,2008. .
Bamberger, DM, GP Daus, and DN Gerding. :Osteomyelitis in the feet of diabetic patients: long-term results, prognostic factors, and the role of antimicrobial and surgical therapy. .Am J Med 83::653. ,1987. .
Aragon-Sanchez, FJ, JJ Cabrera-Galvan, Y Quintana-Marrero, et al. :Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement. .Diabetologia 51.:1962. ,2008. .
Eneroth, M, J Apelqvist, and A Stenstrom. :Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. .Foot Ankle Int 18::716. ,1997. .
Ha Van, G, H Siney, JP Danan, et al. :Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery. .Diabetes Care 19::1257. ,1996. .
Pollard, J, GA Hamilton, SM Rush, et al. :Mortality and morbidity after transmetatarsal amputation: retrospective review of 101 cases. .J Foot Ankle Surg 45::91. ,2006. .
Mwipatayi, BP, NG Naidoo, PC Jeffery, et al. :Transmetatarsal amputation: three-year experience at Groote Schuur Hospital. .World J Surg 29::245. ,2005. .
Stone, PA, MR Back, PA Armstrong, et al. :Midfoot amputations expand limb salvage rates for diabetic foot infections. .Ann Vasc Surg 19::805. ,2005. .
Game, FL and WJ Jeffcoate. :Primarily non-surgical management of osteomyelitis of the foot in diabetes. .Diabetologia 51::962. ,2008. .
Senneville, E, A Lombart, E Beltrand, et al. :Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. .Diabetes Care 31::637. ,2008. .
Diabetic foot osteomyelitis is common and causes substantial morbidity, including major amputations, yet the optimal treatment approach is unclear. We evaluated an approach to limb salvage that combines early surgical debridement or limited amputation with antimicrobial therapy.
We conducted a retrospective cohort study of patients treated between May 1, 2005, and May 31, 2007. The primary end point was cure, defined as not requiring further treatment for osteomyelitis of the affected limb. The secondary end point was limb salvage, defined as not requiring a below-the-knee amputation or a more proximal amputation.
Fifty patients with diabetic foot osteomyelitis met the study criteria. Initial surgical management included local amputation in 43 patients (86%) and debridement without amputation in seven (14%). Most infections (n = 30; 60%) were polymicrobial, and Staphylococcus aureus was the most common pathogen (n = 23; 46%). Parenteral antibiotics were used in 45 patients (90%). Patients who had pathologic evidence of osteomyelitis at the surgical margin received therapy for a median of 43 days (interquartile range [IQR], 36–56 days), whereas those without evidence of residual osteomyelitis received therapy for a median of 19 days (IQR, 13–40 days). Overall, 32 patients (64%) were considered cured after a median follow-up of 26 months (IQR, 12–38 months). Fifteen of 18 patients (83%) who failed initial therapy were treated again with limb-sparing surgery. Limb salvage was achieved in 47 patients (94%), with only three patients (6%) requiring below-the-knee amputation.
In patients with diabetic foot osteomyelitis, surgical debridement or limited amputation plus antimicrobial therapy is effective at achieving clinical cure and limb salvage. (J Am Podiatr Med Assoc 102(4): 273–277, 2012)