Diabetes, Metabolic Syndrome and Obesity (Jun 2019)
Optimal management of diabetic foot osteomyelitis: challenges and solutions
Abstract
José Luis Lázaro Martínez, Yolanda García Álvarez, Aroa Tardáguila-García, Esther García MoralesInstituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid 28040, SpainPurpose: Diabetic foot osteomyelitis (DFO) is the most frequent infection associated with diabetic foot ulcers, occurs in >20% of moderate infections and 50%–60% of severe infections, and is associated with high rates of amputation. DFO represents a challenge in both diagnosis and therapy, and many consequences of its condition are related to late diagnosis, delayed referral, or ill-indicated treatment. This review aimed to analyze the current evidence on DFO management and to discuss advantages and disadvantages of different treatment options.Methods: A narrative review of the evidence was begun by searching Medline and PubMed databases for studies using the keywords “management”, “diabetic foot”, “osteomyelitis”, and “diabetic foot osteomyelitis” from 2008 to 2018.Results: We found a great variety of studies focusing on both medical and surgical therapies showing a similar rate of effectiveness and outcomes; however, the main factors in choosing one over the other seem to be associated with the presence of soft-tissue infection or ischemia and the clinical presentation of DFO.Conclusion: Further randomized controlled trials with large samples and long-term follow-up are necessary to demonstrate secondary outcomes, such as recurrence, recurrent ulceration, and reinfection associated with both medical and surgical options.Keywords: diabetic foot, diabetic foot infection, bone infection, diabetic foot ulcers
