Treating diabetic foot osteomyelitis primarily with surgery or antibiotics: have we answered the question?

Foot infections are among the most frequent diabetes-related causes for hospitalization and the usual immediate predecessor to lower-extremity amputation in these patients (1). Infection usually starts in ulcerated soft tissues, but can spread contiguously to underlying bone (2). Overall, about 20% of patients with a diabetic foot infection (and over 60% of those with severe infections [3]) have underlying osteomyelitis, which dramatically increases the risk of lower-extremity amputation (4). Indeed, optimally managing diabetic foot osteomyelitis is widely considered the most difficult and controversial aspect of dealing with diabetic foot infections (5–7).