Diabetic foot osteomyelitis often leads to amputations in the lower extremity. Data on the influence of the initial anatomical diabetic foot osteomyelitis localization on ultimate major amputation are limited.
Besides advanced ischemia, chronic osteomyelitis of the lower extremity is a frequent problem in patients with longstanding diabetes mellitus and a leading cause of lower extremity amputations.
In the diabetic foot, the severity of systemic manifestations, the number of ulcers, and concomitant vascular insufficiency are influencing factors leading to major amputation
The most common bacterial species identified by intraoperative cultures from bone biopsies in patients with both minor and major amputations were Staphylococcus aureus, followed by coagulase-negative staphylococci and Staphylococcus epidermidis in patients with major amputations and Enterococcus faecalis and Pseudomonas aeruginosa in patients without major amputations
Hindfoot diabetic foot osteomyelitis carries a fivefold risk for diabetic foot osteomyelitis related major amputation compared with forefoot diabetic foot osteomyelitis.
Up to 4.7% of forefoot ulcers in the setting of diabetes mellitus underwent later major amputation
Risk factors such as male gender, elevated HbA1c, increased magnesium and platelet levels were associated in univariate analysis with major amputation.
The most important factor for major amputation after failed forefoot minor amputation was an unsuccessful revascularization.
Charcot Neuroarthropathy was most prevalent in midfoot diabetic foot osteomyelitis, capable of causing major destruction and foot deformation, resulting in pressure areas that facilitate skin lesions and wound healing problems.
Diabetic foot osteomyelitis may occur simultaneously to gangrene, soft tissue infection, or sepsis.
The frequency of limb loss in diabetic foot osteomyelitis increases the more proximal the initial diabetic foot osteomyelitis lesion occurs in the foot, with almost half of patients losing their limbs suffering from hindfoot diabetic foot osteomyelitis. Only hindfoot diabetic foot osteomyelitis was found to be an independent risk factor for diabetic foot osteomyelitis related major amputation both initially and after initial partial foot amputation care.
Source: Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients with Diabetes. Foot & Ankle International® 2022