Treatment of diabetic foot osteomyelitis: A surgical critique

Int J Low Extrem Wounds. 2010 Mar;9(1):37-59. doi: 10.1177/1534734610361949.


Osteomyelitis is one of the most frequent infections of the diabetic foot accounting for 10-15% of mild infections and almost 50% of severe infections. The definitive diagnosis of foot osteomyelitis requires obtaining bone samples for microbiological and histopathological studies. The treatment of osteomyelitis of the foot in diabetic patients continues to be debated. Until recently, most experts considered that the standard treatment for diabetic foot osteomyelitis should be the surgical removal of infected bone. Recent data suggest that antibiotic treatment can achieve an apparent remission of osteomyelitis though it is difficult to identify patients for this approach. One of the main arguments used to justify the solely antibiotic treatment of osteomyelitis is the alteration of foot biomechanics produced as a consequence of surgery. Conservative surgery combined with antibiotics is an attractive option in treating diabetic foot osteomyelitis because it may reduce the changes in the biomechanics of the foot and minimize the duration of antibiotic therapy. It is currently accepted that the combination of antibiotics with surgical removal of the infected bone may cure the majority of diabetic foot osteomyelitis. Recent literature emphasizes the role of antibiotics in the management of foot infections while little effort is dedicated to reviewing the surgical treatment of this challenging diabetic complication, apart from amputation. More research, including studies of adjunctive therapies in cases of bone infection in the feet of diabetic patients is required.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amputation, Surgical* / adverse effects
  • Amputation, Surgical* / methods
  • Amputation, Surgical* / statistics & numerical data
  • Anti-Bacterial Agents / therapeutic use
  • Biomechanical Phenomena
  • Biopsy
  • Combined Modality Therapy
  • Debridement* / adverse effects
  • Debridement* / methods
  • Debridement* / statistics & numerical data
  • Diabetic Foot / complications*
  • Evidence-Based Practice
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteomyelitis / diagnosis
  • Osteomyelitis / drug therapy
  • Osteomyelitis / etiology
  • Osteomyelitis / surgery*
  • Osteotomy* / adverse effects
  • Osteotomy* / methods
  • Osteotomy* / statistics & numerical data
  • Patient Selection
  • Postoperative Care
  • Practice Guidelines as Topic
  • Skin Care
  • Treatment Outcome
  • Unnecessary Procedures
  • Wound Healing


  • Anti-Bacterial Agents