Amputation Versus Primary Nonoperative Management Of Chronic Osteomyelitis Involving A Pedal Digit In Diabetic Patients

Background: The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis.Methods: We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated.Results: The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean 6 SD total duration of hospitalization was 24.05 +/- 15.43 and 20.67 +/- 15.97 days, respectively (P = .43). The mean 6 SD number of rehospitalizations after infection recurrence was 2.62 +/- 1.63 and 1.67 +/- 1.24, respectively (P = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (P=.69).Conclusions: Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.