A Review of Diabetic Foot Osteomyelitis: Focus on Diagnosis, Clinical Presentation, Management and Outcomes

Abstract

Diabetic foot osteomyelitis (DFO) affects around 38.5 lakh patients in India. It is diagnosed using clinical and radiologicalapproaches. Polymicrobial etiology, peripheral artery disease (PAD) and peripheral neuropathy are commonly observed. Ahigh degree of clinical vigil is required to avoid underestimation of the extent of damage due to speed and spread of infectionand prevent chances of lower extremity amputation. ‘Time is Tissue’ (time taken to access multidisciplinary care) aptlyrepresents one of the critical factors affecting outcomes, along with anatomical location and presence of gangrenous tissues.Traditionally, DFO treatment is the most complex and controversial aspect of managing diabetic foot infections (DFIs). Thetherapeutic paradigm has evolved from high-level surgical resection of all necrotic and infected bone to the more refined andindividualized surgical interventions along with appropriate antibiotics and topical antimicrobials. It is necessary to have asurgeon available with diabetic foot expertise. The surgical outcome is facilitated with strict off-loading, wound management,agitation (freshening and scrapping of wound edges), biofilm disruption and negative pressure wound therapy (NPWT) toaccelerate healing. Formal protocol-driven treatment can be provided by a multidisciplinary team involving surgical, medicaland podiatric specialties to reduce hospital stay and the need for repeat debridement.This review aims to present a completeoverview of the diagnosis, clinical presentation, management and outcomes of DFO according to scientific recommendationsand our experience, along with few illustrative case reports.