Brief report
Conservative management of diabetic foot osteomyelitis

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Abstract

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p = 0.04) which was defined as death, amputation and failure to heal.

Introduction

Diabetic foot ulcer (DFU) infection and osteomyelitis increase the risk of lower limb amputation [1], [2], [3]. The prevalence of osteomyelitis (OM) varies between 20 and 68% [4], [5], [6]. Resection of infected and necrotic bone has been advocated as the treatment for patients with osteomyelitis [7], [8], [9]. However, this condition is increasingly treated medically [10], [11], [12], [13], [14], [15]. There are no randomised controlled trials to compare surgical intervention with medical treatment and recent guideline suggests either treatment can be used at the clinician's judgment [16]. In our centre, a multidisciplinary approach is adopted and osteomyelitis is primarily treated with prolonged oral antibiotic therapy and surgery is reserved for failed medical therapy. The aim of this study was to analyse the outcome of patients diagnosed with diabetic foot osteomyelitis in our clinic.

Section snippets

Research design and methods

This was a retrospective study of all consecutive patients attending the multidisciplinary diabetic foot service at Lancashire Teaching Hospitals between 2003 and 2008. Diagnosis of osteomyelitis was made clinically based on the presence of a chronic ulcer (>4 weeks duration) over a bony surface probing to bone, visible bone at the base of ulcer or sausage toe deformity. In the majority of cases it was confirmed radiologically with X-ray, bone scan or leucoscan. Subjects who had limb

Results

During this period, 130 cases of osteomyelitis due to DFU were identified. The mean age was 66.2 (±14.4) and duration of diabetes was 13.2 (±10.9) years. The majority were male (66.9%) and 80% had type 2 diabetes. The distribution of osteomyelitis in the foot was 65 cases in the toes, 46 in the metatarsals, 2 in the malleoli and 11 in the calcaneum. The exact location of osteomyelitis was not specified in the clinic notes of 6 patients and was recorded only as right or left foot. Peripheral

Conclusions

Medical rather than surgical treatment of osteomyelitis is increasingly being used in clinical practice in the absence of severe infection or critical ischemic [10], [11], [12], [13], [14], [15]. Medical treatment was successful in treating osteomyelitis in 66.9% of our patients which is similar to other published series [10], [12], [13], [14]. 12.3% of subjects needed minor amputation, mostly in the form of Ray's amputation which is comparable to other published series [10], [12]. Hospital

Conflict of interest

There is no conflict of interest.

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