Osteomyelitis Management in Diabetic Foot Ulcers

Osteomyelitis in the context of diabetic foot ulcers arises when bacterial or fungal pathogens invade bone tissue beneath a chronic skin lesion. Neuropathy, peripheral arterial disease and impaired immune responses combine to delay wound healing and facilitate deep infection. Early recognition relies on clinical examination, laboratory markers of inflammation and magnetic resonance imaging to delineate bone involvement. Management is inherently multidisciplinary, combining targeted systemic antibiotics with surgical debridement of necrotic tissue. Advanced modalities such as negative-pressure wound therapy and local antibiotic delivery systems have emerged to enhance granulation, reduce microbial load and preserve limb function. Reconstructive techniques—from bone graft substitutes to vascularised flaps—address osseous defects while striving to maintain mobility and prevent amputation. Prevention and patient education remain cornerstones, with off-loading strategies and glycaemic control critical to reducing recurrence. Globally, the burden of diabetic foot osteomyelitis is rising, underscoring the need for integrated care pathways and cost-effective therapies that can be applied across diverse healthcare settings.

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Osteomyelitis Management in Diabetic Foot Ulcers publication trend

The graph below shows the total number of articles in osteomyelitis management in diabetic foot ulcers across all publications each year (not limited to Nature Index journals).

Technical terms

Osteomyelitis: Infection and inflammation of bone tissue, often requiring combined medical and surgical intervention.

Debridement: Surgical removal of necrotic, infected or non-viable tissue to promote healing and reduce microbial burden.

Negative-pressure wound therapy (NPWT): A technique using controlled suction under a sealed dressing to remove exudate and stimulate granulation tissue.

Vacuum sealing drainage (VSD): A variant of NPWT employing a foam interface and drainage tubes to apply uniform negative pressure across the wound bed.

Antibiotic-loaded calcium sulphate: A biodegradable bone void filler that elutes antibiotics locally to sustain high antimicrobial concentrations without systemic toxicity.

Gentamicin-impregnated cement: Polymethylmethacrylate mixed with gentamicin to provide both structural support and targeted antibiotic delivery within bony cavities.

References

1. Management of a Difficult‐to‐Treat Diabetic Foot Wound Complicated by Osteomyelitis: A Case Study. Case Reports in Surgery (2020).
2. Vacuum sealing drainage combined with eggshell-like debridement antibiotic-loaded calcium sulphate for calcaneal osteomyelitis. Journal of Orthopaedic Surgery and Research (2023).
3. Gentamicin-permeated cement to sustain mechanical support for the treatment of a chronic calcaneal abscess. A case report. International Journal of Surgery Case Reports (2023).