Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

Diabetologia. 2008 Nov;51(11):1962-70. doi: 10.1007/s00125-008-1131-8. Epub 2008 Aug 22.


Aims/hypothesis: We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabetic patients given early surgical treatment within 12 h of admission and treated with prioritisation of foot-sparing surgery and avoidance of amputation.

Methods: A consecutive series of 185 diabetic patients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death.

Results: Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection.

Conclusions/interpretation: Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.

MeSH terms

  • Amputation, Surgical / statistics & numerical data
  • Bacteria / isolation & purification
  • Blood Urea Nitrogen
  • Calcaneus / surgery
  • Diabetic Foot / blood
  • Diabetic Foot / complications*
  • Diabetic Foot / microbiology
  • Diabetic Foot / pathology
  • Diabetic Foot / surgery*
  • Foot Ulcer / epidemiology
  • Humans
  • Leukocyte Count
  • Metatarsus / surgery
  • Osteomyelitis / etiology
  • Osteomyelitis / microbiology
  • Osteomyelitis / pathology
  • Osteomyelitis / surgery*
  • Platelet Count
  • Sesamoid Bones / surgery
  • Toe Phalanges / surgery
  • Treatment Outcome