This article was a systematic review that aimed to review the treatment options for diabetic foot osteomyelitis (DFO). It focused on 3 treatment options: 1) medical therapy; 2) surgical therapy; 3) adjunctive treatments. Medical therapy was antibiotic therapy, and the study evaluated the efficacy, routes, and duration of its use, and compared them with surgical interventions to determine the best practices for managing DFO. It included studies published in English or Spanish focusing on therapeutic interventions for DFO, and excluded diagnostic, preventive, and educational interventions, and unoriginal articles, letters, comments, case series, and studies without analyzable data.
The authors found that of the 9 studies that focused on antibiotic therapy alone, antibiotics alone showed remission rates between 63.5% and 82.3%. The main advantages of this approach are the avoidance of biomechanical changes (i.e. changes to foot structure and mechanical forces), and lower hospitalization costs. However, antibiotic monotherapy poses risks of recurrent infections and antibiotic-related adverse effects. Of the 9 studies that focused on surgical interventions (which included: bone resection or debridement aimed at removing infected bone and tissues to control the infection), they showed similar remission rates to medical treatment, and their utility was emphasized in cases with systemic toxicity, significant bone destruction, or infected joint spaces. Surgical interventions however incur higher costs and the risks of operative complications. 3 studies investigated combined medical and surgical treatments and results indicated that combined approaches can lead to acceptable limb-salvage rates and reduced treatment durations. The authors also included studies that examined the efficacy of adjuvant treatments (e.g. hyperbaric oxygen therapy, local antibiotic-delivery systems), but results were inconclusive due to insufficient data.
Overall, the study was a comprehensive review that covered a decade of research, used multiple databases to ensure extensive coverage, and the inclusion of both medical and surgical treatment options provided a balanced overview. However, it suffered from high variability in study designs and methodologies (which limited direct comparison), a majority of retrospective studies that lacked long-term follow-up, and the inclusion of only one randomized controlled trial (RCT) was identified, highlighting the need for stronger, more rigorous research. And so while the review found effectiveness and advantages of surgical and medical interventions and the two interventions combined, the limitations – especially the lack of more rigorous study designs – suggest that the choice of treatment in DFO should be individualized based on patient comorbidities, the extent of infection, and the availability of surgical expertise.
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