Sapico FL & Bessman AN: “Diabetic Foot Infections,” in The High Risk Foot in Diabetes Mellitus, edited by Fryberg, RG p 197, Churchill Livingstone, New York, 1991.
Senneville E & Nguyen S: Difficult situations managing diabetic foot: evidences and personal views: is to operate on patients with diabetic foot osteomyelitis old-fashioned? Int J Low Extrem Wounds 13: 241, 2014.
Hartemann-Heurtier A & Senneville E: Diabetic foot osteomyelitis. Diabetes Metab 34: 87, 2008.
Senneville E , Melliez H & Beltrand E et al.: Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis 42: 57, 2006.
Ha Van G , Siney H & Danan JP et al.: Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery. Diabetes Care 19: 1257, 1996.
Pittet D , Wyssa B & Herter-Clavel C et al.: Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up. Arch Intern Med 159: 851, 1999.
Nehler MR , Whitehill TA & Bowers SP et al.: Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status. J Vasc Surg 30: 509, 1999.
Tan JS , Friedman NM & Hazelton-Miller C et al.: Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin Infect Dis 23: 286, 1996.
Bamberger DM , Daus GP & Gerding DN: 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.
Embil J: The management of diabetic foot osteomyelitis. Diabet Foot 3: 76, 2000.
Eneroth M , Larsson J & Apelqvist J: Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis. J Diabetes Complications 13: 254, 1999.
Nix DK , Cumbo TJ & Kuritzky P et al.: Oral ciprofloxacin in the treatment of serious soft tissue and bone infection: efficacy, safety, and pharmacokinetics. Am J Med 82 (suppl 4A) : 146, 1987.
Senneville E , Yazdanpanah Y & Cazaubiel M et al.: Rifampicin-ofloxacin oral regimen for the treatment of mild to moderate diabetic foot osteomyelitis. J Antimicrob Chemother 48: 927, 2001.
Venkatesan P , Lawn S & Macfarlane RM et al.: Conservative management of osteomyelitis in the feet of diabetic patients. Diabet Med 14: 487, 1997.
Yadlapalli N , Vaishnar A & Sheehan P: Conservative management of diabetic foot ulcers complicated by osteomyelitis. Wounds 14: 31, 2002.
Berendt AR , Peters EJ & Bakker K 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.
Lipsky BA , Aragón-Sánchez J & Diggle M et al; International Working Group on the Diabetic Foot: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 32 (suppl 1) : 45, 2016.
Aragon-Sanchez J: Treatment of diabetic foot osteomyelitis: a surgical critique. Int J Low Extrem Wounds 9: 37, 2010.
Mikus JR , Worsham J & Aung, H et al.: The role of bone biopsy in osteomyelitis: utility or futility? J Vasc Interv Radiol 24: S31, 2013.
Mann RA , Poppen NK & O'Konski M: Amputation of the great toe: a clinical and biomechanical study. Clin Orthop Relat Res 226: 192, 1988.
Jeffcoate WJ & Lipsky BA: Controversies in diagnosing and managing osteomyelitis of the foot in diabetes. Clin Infect Dis 39 (suppl 2) : S115, 2004.
Jeffcoate WJ , Lipsky BA & Berendt AR et al; International Working Group on the Diabetic Foot: Unresolved issues in the management of ulcers of the foot in diabetes. Diabet Med 25: 1380, 2008.
Waldvogel FA & Papageorgiou PS: Osteomyelitis: the past decade. N Engl J Med 303: 360, 1980.
Powers JH: Development of drugs for antimicrobial-resistant pathogens. Curr Opin Infect Dis 16: 547, 2003.
Aragón-Sánchez J & Lipsky BA: Modern management of diabetic foot osteomyelitis: the when, how and why of conservative approaches. Expert Rev Anti Infect Ther 16: 35, 2018.
Lázaro-Martínez J , Aragón-Sánchez J & García-Morales E: Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes Care 37: 789, 2014.
The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis.
We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated.
The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean ± SD total duration of hospitalization was 24.05 ± 15.43 and 20.67 ± 15.97 days, respectively (P = .43). The mean ± SD number of rehospitalizations after infection recurrence was 2.62 ± 1.63 and 1.67 ± 1.24, respectively (P = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (P = .69).
Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.
Orthopedic Department, Sapir Medical Center, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Orthopedic Surgery, Assuta Medical Center, Ashdod, Israel; Faculty of Health and Science, Ben Gurion University of the Negev, Beer-Sheva, Israel.