Approach to the Treatment of Diabetic Foot OsteomyelitisInsertion of Bioactive BONALIVE Via Plantar Approach and Consequently External Fixation for Diabetic Foot Osteomyelitis: A Case Report

Abstract

Diabetic foot osteomyelitis (DFO) is a clinical problem with a high risk of amputation, and it is always a complication of a preexisting infected foot wound. Prevalence can be as high as 60%. There is no consensus in the current literature regarding the management of these patients and this remains an unsolved challenge for the case manager. Surgical therapy, antibiotic therapy, or conservative treatment are among the current common treatments. Each one of them has its inherent advantage and disadvantages. In the past few years, Bioactive and soluble glasses have had the potential for use in wound healing and infection eradication. The use of new bone substitutes aims to support the load of the bone segments and to ensure the eradication of the infectious process. The approach to the infection is also a challenge. We present the management of a case of DFO that has been treated by systemic antibiotics and the insertion of bioglass, Bonalive, via plantar approach and additional external fixation. This novel way of treatment allows the closure of a diabetic ulcer that was already planned for below-knee amputation (BKA) in other institutions. A long follow-up shows the resolution of the infectious process, no ulcer recurrence, and persistent recovery of the ability to walk. Our results are in line with current literature that suggests bioglass may be considered a useful option to manage DFO and achieve healing with a very conservative approach.