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Optimal management of diabetic foot osteomyelitis: challenges and solutions

Authors Lázaro Martínez JL, García Álvarez Y, Tardáguila-García A, García Morales E

Received 8 February 2019

Accepted for publication 3 May 2019

Published 21 June 2019 Volume 2019:12 Pages 947—959

DOI https://doi.org/10.2147/DMSO.S181198

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Antonio Brunetti


José Luis Lázaro Martínez, Yolanda García Álvarez, Aroa Tardáguila-García, Esther García Morales

Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid 28040, Spain

Purpose: 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


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