Skip to main content
SpringerLink
Log in

Surgical Management of Diabetic Foot Infection and Osteomyelitis

  • Chapter
  • First Online:
Functional Limb Salvage

  • 257 Accesses

Abstract

Diabetic foot infections can involve the soft tissues and bone components. Clinical assessment of an infected diabetic foot requires a systematic approach and multidisciplinary input. Infections that are associated with progressive spread and tissue necrosis often warrant surgical debridement. The technique of surgical debridement of an infected diabetic foot ulcer includes specific measures that allow complete resection of the infected tissues and retention of non-infected areas. In addition, targeted antibiotic administration, advanced wound healing techniques, and protective offloading measures ensure predictable healing and functional limb salvage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Geraghty T, LaPorta G. Current health and economic burden of chronic diabetic osteomyelitis. Expert Rev Pharmacoecon Outcomes Res. 2019;19:279–86.

    Article  PubMed  Google Scholar 

  2. Lin CW, Armstrong DG, Lin CH, Liu PH, Hung SY, Lee SR, et al. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care. 2019;7:e000795.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hicks CW, Selvarajah S, Mathioudakis N, Sherman RE, Hines KF, Black JH III, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg. 2016;33:149–58.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sen P, Demirdal T, Emir B. Meta-analysis of risk factors for amputation in diabetic foot infections. Diabetes Metab Res Rev. 2019;35:e3165.

    Article  PubMed  Google Scholar 

  5. Lavery LA, Armstrong DG, Murdoch DP, Peters EJ, Lipsky BA. Validation of the Infectious Diseases Society of America’s diabetic foot infection classification system. Clin Infect Dis. 2007;44:562–5.

    Article  PubMed  Google Scholar 

  6. Hartemann-Heurtier A, Ha Van G, Danan JP, Koskas F, Jacqueminet S, Golmard JL, et al. Outcome of severe diabetic foot ulcers after standardised management in a specialised unit. Diabetes Metab. 2002;28:477–84.

    CAS  PubMed  Google Scholar 

  7. Saltoglu N, Ergonul O, Tulek N, Yemisen M, Kadanali A, Karagoz G, et al. Influence of multidrug resistant organisms on the outcome of diabetic foot infection. Int J Infect Dis. 2018;70:10–4.

    Article  PubMed  Google Scholar 

  8. Arias M, Hassan-Reshat S, Newsholme W. Retrospective analysis of diabetic foot osteomyelitis management and outcome at a tertiary care hospital in the UK. PLoS One. 2019;14:e0216701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ghanassia E, Villon L, Thuan Dit Dieudonne JF, Boegner C, Avignon A, Sultan A. Long-term outcome and disability of diabetic patients hospitalized for diabetic foot ulcers: a 6.5-year follow-up study. Diabetes Care. 2008;31:1288–92.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lipsky BA, Senneville E, Abbas ZG, Aragon-Sanchez J, Diggle M, Embil JM, et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3280.

    Article  PubMed  Google Scholar 

  11. van Baal JG. Surgical treatment of the infected diabetic foot. Clin Infect Dis. 2004;39(Suppl 2):S123–8.

    Article  PubMed  Google Scholar 

  12. Faglia E, Clerici G, Caminiti M, Quarantiello A, Gino M, Morabito A. The role of early surgical debridement and revascularization in patients with diabetes and deep foot space abscess: retrospective review of 106 patients with diabetes. J Foot Ankle Surg. 2006;45:220–6.

    Article  PubMed  Google Scholar 

  13. Tan JS, Friedman NM, Hazelton-Miller C, Flanagan JP, File TM Jr. Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation? Clin Infect Dis. 1996;23:286–91.

    Article  CAS  PubMed  Google Scholar 

  14. Armstrong DG, Lipsky BA. Diabetic foot infections: stepwise medical and surgical management. Int Wound J. 2004;1:123–32.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gibbons GW. The diabetic foot: amputations and drainage of infection. J Vasc Surg. 1987;5:791–3.

    Article  CAS  PubMed  Google Scholar 

  16. Taylor LM Jr, Porter JM. The clinical course of diabetics who require emergent foot surgery because of infection or ischemia. J Vasc Surg. 1987;6:454–9.

    Article  PubMed  Google Scholar 

  17. Chang BB, Darling RC III, Paty PS, Lloyd WE, Shah DM, Leather RP. Expeditious management of ischemic invasive foot infections. Cardiovasc Surg. 1996;4:792–5.

    Article  CAS  PubMed  Google Scholar 

  18. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885–910.

    Article  PubMed  Google Scholar 

  19. Peters EJG, Lipsky BA, Senneville E, Abbas ZG, Aragon-Sanchez J, Diggle M, et al. Interventions in the management of infection in the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3282.

    Article  PubMed  Google Scholar 

  20. Eneroth M, Apelqvist J, Stenstrom A. Clinical characteristics and outcome in 223 diabetic patients with deep foot infections. Foot Ankle Int. 1997;18:716–22.

    Article  CAS  PubMed  Google Scholar 

  21. Aragon-Sanchez J. Clinical-pathological characterization of diabetic foot infections: grading the severity of osteomyelitis. Int J Low Extrem Wounds. 2012;11:107–12.

    Article  PubMed  Google Scholar 

  22. Aragon-Sanchez J. Seminar review: a review of the basis of surgical treatment of diabetic foot infections. Int J Low Extrem Wounds. 2011;10:33–65.

    Article  PubMed  Google Scholar 

  23. Aragon-Sanchez FJ, Cabrera-Galvan JJ, Quintana-Marrero Y, Hernandez-Herrero MJ, Lazaro-Martinez JL, Garcia-Morales E, et al. Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement. Diabetologia. 2008;51:1962–70.

    Article  CAS  PubMed  Google Scholar 

  24. Aragon-Sanchez J, Quintana-Marrero Y, Lazaro-Martinez JL, Hernandez-Herrero MJ, Garcia-Morales E, Beneit-Montesinos JV, et al. Necrotizing soft-tissue infections in the feet of patients with diabetes: outcome of surgical treatment and factors associated with limb loss and mortality. Int J Low Extrem Wounds. 2009;8:141–6.

    Article  PubMed  Google Scholar 

  25. Lavery LA, Ryan EC, Ahn J, Crisologo PA, Oz OK, La Fontaine J, et al. The infected diabetic foot: re-evaluating the Infectious Diseases Society of America diabetic foot infection classification. Clin Infect Dis. 2020;70:1573–9.

    Article  PubMed  Google Scholar 

  26. Wukich DK, Hobizal KB, Sambenedetto TL, Kirby K, Rosario BL. Outcomes of osteomyelitis in patients hospitalized with diabetic foot infections. Foot Ankle Int. 2016;37:1285–91.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Aragon-Sanchez J, Viquez-Molina G, Lopez-Valverde ME, Rojas-Bonilla JM, Murillo-Vargas C. Surgical diabetic foot infections: is osteomyelitis associated with a worse prognosis? Int J Low Extrem Wounds. 2023;22(1):36–43.

    Article  PubMed  Google Scholar 

  28. Lavery LA, Peters EJ, Armstrong DG, Wendel CS, Murdoch DP, Lipsky BA. Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Res Clin Pract. 2009;83:347–52.

    Article  PubMed  Google Scholar 

  29. Edelson GW, Armstrong DG, Lavery LA, Caicco G. The acutely infected diabetic foot is not adequately evaluated in an inpatient setting. J Am Podiatr Med Assoc. 1997;87:260–5.

    Article  CAS  PubMed  Google Scholar 

  30. Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273:721–3.

    Article  CAS  PubMed  Google Scholar 

  31. Alvaro-Afonso FJ, Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E, Garcia-Alvarez Y, Molines-Barroso RJ. Inter-observer reproducibility of diagnosis of diabetic foot osteomyelitis based on a combination of probe-to-bone test and simple radiography. Diabetes Res Clin Pract. 2014;105:e3–5.

    Article  PubMed  Google Scholar 

  32. Aragon-Sanchez J, Lipsky BA, Lazaro-Martinez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients? Diabet Med. 2011;28:191–4.

    Article  CAS  PubMed  Google Scholar 

  33. Aragón-Sánchez J, Lipsky BA, Lázaro-Martínez JL. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone and plain radiography sufficient for high risk inpatients? Diabet Med. 2011;28(2):191–4. https://doi.org/10.1111/j.1464-5491.2010.03150.x.

    Article  PubMed  Google Scholar 

  34. Lam K, van Asten SA, Nguyen T, La Fontaine J, Lavery LA. Diagnostic accuracy of probe to bone to detect osteomyelitis in the diabetic foot: a systematic review. Clin Infect Dis. 2016;63:944–8.

    Article  PubMed  Google Scholar 

  35. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47:519–27.

    Article  PubMed  Google Scholar 

  36. Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA. 2008;299:806–13.

    Article  CAS  PubMed  Google Scholar 

  37. Senneville EM, Lipsky BA, van Asten SAV, Peters EJ. Diagnosing diabetic foot osteomyelitis. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3250.

    Article  PubMed  Google Scholar 

  38. Dinh T, Snyder G, Veves A. Current techniques to detect foot infection in the diabetic patient. Int J Low Extrem Wounds. 2010;9:24–30.

    Article  PubMed  Google Scholar 

  39. Morrison WB, Schweitzer ME, Wapner KL, Hecht PJ, Gannon FH, Behm WR. Osteomyelitis in feet of diabetics: clinical accuracy, surgical utility, and cost-effectiveness of MR imaging. Radiology. 1995;196:557–64.

    Article  CAS  PubMed  Google Scholar 

  40. Fujii M, Armsrong DG, Terashi H. Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia. J Foot Ankle Surg. 2013;52:717–23.

    Article  PubMed  Google Scholar 

  41. Valabhji J, Oliver N, Samarasinghe D, Mali T, Gibbs RG, Gedroyc WM. Conservative management of diabetic forefoot ulceration complicated by underlying osteomyelitis: the benefits of magnetic resonance imaging. Diabet Med. 2009;26:1127–34.

    Article  CAS  PubMed  Google Scholar 

  42. Karchmer AW, Gibbons GW. Foot infections in diabetes: evaluation and management. Curr Clin Top Infect Dis. 1994;14:1–22.

    CAS  PubMed  Google Scholar 

  43. Ahluwalia R, Vainieri E, Tam J, Sait S, Sinha A, Manu CA, Reichert I, Kavarthapu V, Edmonds M, Vas P. Surgical diabetic foot debridement: improving training and practice utilizing the traffic light principle. Int J Low Extrem Wounds. 2019;18(3):279–86. https://doi.org/10.1177/1534734619853657. Epub 2019 Jun 25. PMID: 31237147.

    Article  PubMed  Google Scholar 

  44. Schmidt BM, Jarocki C. Making the equivocal unequivocal: standardization of clean margins in diabetic foot osteomyelitis. Clin Diabetes Endocrinol. 2020;6:8.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Atway S, Nerone VS, Springer KD, Woodruff DM. Rate of residual osteomyelitis after partial foot amputation in diabetic patients: a standardized method for evaluating bone margins with intraoperative culture. J Foot Ankle Surg. 2012;51:749–52.

    Article  PubMed  Google Scholar 

  46. Shiraev TP, Lipsky BA, Kwok TMY, Robinson DA. Utility of culturing marginal bone in patients undergoing lower limb amputation for infection. J Foot Ankle Surg. 2019;58:847–51.

    Article  PubMed  Google Scholar 

  47. Rossel A, Lebowitz D, Gariani K, Abbas M, Kressmann B, Assal M, et al. Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—a daily practice cohort. Endocrinol Diabetes Metab. 2019;2:e00059.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gariani K, Pham TT, Kressmann B, Jornayvaz FR, Gastaldi G, Stafylakis D, et al. Three versus six weeks of antibiotic therapy for diabetic foot osteomyelitis: a prospective, randomized, non-inferiority pilot trial. Clin Infect Dis. 2020;73:e1539.

    Article  Google Scholar 

  49. Cuttica DJ, Philbin TM. Surgery for diabetic foot infections. Foot Ankle Clin. 2010;15:465–76.

    Article  PubMed  Google Scholar 

  50. Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Feasibility and effectiveness of internal pedal amputation of phalanx or metatarsal head in diabetic patients with forefoot osteomyelitis. J Foot Ankle Surg. 2012;51:593.

    Article  PubMed  Google Scholar 

  51. Ha Van G, Siney H, Danan JP, Sachon C, Grimaldi A. Treatment of osteomyelitis in the diabetic foot. Contribution of conservative surgery. Diabetes Care. 1996;19:1257–60.

    Article  CAS  PubMed  Google Scholar 

  52. Aragon-Sanchez J, Lazaro-Martinez JL, Alvaro-Afonso FJ, Molines-Barroso R. Conservative surgery of diabetic forefoot osteomyelitis: how can I operate on this patient without amputation? Int J Low Extrem Wounds. 2015;14:108–31.

    Article  PubMed  Google Scholar 

  53. Sanz-Corbalan I, Lazaro-Martinez JL, Garcia-Alvarez Y, Garcia-Morales E, Alvaro-Afonso F, Molines-Barroso R. Digital deformity assessment prior to percutaneous flexor tenotomy for managing diabetic foot ulcers on the toes. J Foot Ankle Surg. 2019;58:453–7.

    Article  PubMed  Google Scholar 

  54. Kim JY, Kim TW, Park YE, Lee YJ. Modified resection arthroplasty for infected non-healing ulcers with toe deformity in diabetic patients. Foot Ankle Int. 2008;29:493–7.

    Article  CAS  PubMed  Google Scholar 

  55. Melamed EA, Peled E. Antibiotic impregnated cement spacer for salvage of diabetic osteomyelitis. Foot Ankle Int. 2012;33:213–9.

    Article  PubMed  Google Scholar 

  56. Aragon-Sanchez J. Treatment of diabetic foot osteomyelitis: a surgical critique. Int J Low Extrem Wounds. 2010;9:37–59.

    Article  PubMed  Google Scholar 

  57. Aragon-Sanchez J, Lazaro-Martinez JL, Quintana-Marrero Y, Sanz-Corbalan I, Hernandez-Herrero MJ, Cabrera-Galvan JJ. Super-oxidized solution (Dermacyn Wound Care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: preliminary experience in a specialized department. Int J Low Extrem Wounds. 2013;12:130–7.

    Article  CAS  PubMed  Google Scholar 

  58. Aragon-Sanchez J, Lazaro-Martinez JL, Hernandez-Herrero C, Campillo-Vilorio N, Quintana-Marrero Y, Garcia-Morales E, et al. Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series. Diabet Med. 2012;29:813–8.

    Article  CAS  PubMed  Google Scholar 

  59. Frykberg R, Wukich D, Kavarthapu V, Zgonis T, Dalla Paola L. Surgery for the diabetic foot: a key component of care. Diabetes Metab Res Rev. 2020;36(Suppl 1):e3251.

    Article  PubMed  Google Scholar 

  60. Wieman TJ, Mercke YK, Cerrito PB, Taber SW. Resection of the metatarsal head for diabetic foot ulcers. Am J Surg. 1998;176:436–41.

    Article  CAS  PubMed  Google Scholar 

  61. Freeman GJ, Mackie KM, Sare J, Walsh AK, Pherwani AD. A novel approach to the management of the diabetic foot: metatarsal excision in the treatment of osteomyelitis. Eur J Vasc Endovasc Surg. 2007;33:217–9.

    Article  CAS  PubMed  Google Scholar 

  62. Armstrong DG, Rosales MA, Gashi A. Efficacy of fifth metatarsal head resection for treatment of chronic diabetic foot ulceration. J Am Podiatr Med Assoc. 2005;95:353–6.

    Article  PubMed  Google Scholar 

  63. Rosenblum BI, Pomposelli FB Jr, Giurini JM, Gibbons GW, Freeman DV, Chrzan JS, et al. Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience. Diabetes Care. 1994;17:983–7.

    Article  CAS  PubMed  Google Scholar 

  64. Piaggesi A, Schipani E, Campi F, Romanelli M, Baccetti F, Arvia C, et al. Conservative surgical approach versus non-surgical management for diabetic neuropathic foot ulcers: a randomized trial. Diabet Med. 1998;15:412–7.

    Article  CAS  PubMed  Google Scholar 

  65. Tardaguila-Garcia A, Sanz-Corbalan I, Molines-Barroso RJ, Alvaro-Afonso FJ, Garcia-Alvarez Y, Lazaro-Martinez JL. Complications associated with the approach to metatarsal head resection in diabetic foot osteomyelitis. Int Wound J. 2019;16:467–72.

    Article  PubMed  Google Scholar 

  66. Molines-Barroso RJ, Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E, Beneit-Montesinos JV, Alvaro-Afonso FJ. Analysis of transfer lesions in patients who underwent surgery for diabetic foot ulcers located on the plantar aspect of the metatarsal heads. Diabet Med. 2013;30:973–6.

    Article  CAS  PubMed  Google Scholar 

  67. Aprile I, Galli M, Pitocco D, Di Sipio E, Simbolotti C, Germanotta M, et al. Does first ray amputation in diabetic patients influence gait and quality of life? J Foot Ankle Surg. 2018;57:44–51.

    Article  PubMed  Google Scholar 

  68. Borg I, Mizzi S, Formosa C. Plantar pressure distribution in patients with diabetic peripheral neuropathy and a first-ray amputation. J Am Podiatr Med Assoc. 2018;108:225–30.

    Article  PubMed  Google Scholar 

  69. Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, Morgan CB, Lavery LA. The natural history of great toe amputations. J Foot Ankle Surg. 1997;36:204–8; discussion 256.

    Article  CAS  PubMed  Google Scholar 

  70. Dalla Paola L, Faglia E, Caminiti M, Clerici G, Ninkovic S, Deanesi V. Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study. Diabetes Care. 2003;26:1874–8.

    Article  PubMed  Google Scholar 

  71. Borkosky SL, Roukis TS. Incidence of repeat amputation after partial first ray amputation associated with diabetes mellitus and peripheral neuropathy: an 11-year review. J Foot Ankle Surg. 2013;52:335–8.

    Article  PubMed  Google Scholar 

  72. Fontalis A, Doorgakant A, Zahra W, Blundell C. Midfoot Charcot neuro-arthropathy precipitated by first or fifth ray amputation. Foot Ankle Surg. 2020;27:673.

    Article  PubMed  Google Scholar 

  73. Johnson JE, Anderson SA. One stage resection and pin stabilization of first metatarsophalangeal joint for chronic plantar ulcer with osteomyelitis. Foot Ankle Int. 2010;31:973–9.

    Article  PubMed  Google Scholar 

  74. Schweinberger MH, Roukis TS. Salvage of the first ray with external fixation in the high-risk patient. Foot Ankle Spec. 2008;1:210–3.

    Article  PubMed  Google Scholar 

  75. Dalla Paola L, Carone A, Morisi C, Cardillo S, Pattavina M. Conservative surgical treatment of infected ulceration of the first metatarsophalangeal joint with osteomyelitis in diabetic patients. J Foot Ankle Surg. 2015;54:536–40.

    Article  PubMed  Google Scholar 

  76. Fowler E, Scott-Williams S, McGuire JB. Practice recommendations for preventing heel pressure ulcers. Ostomy Wound Manag. 2008;54(10):42–8.

    Google Scholar 

  77. Cook J, et al. A retrospective assessment of partial calcanectomies and factors influencing postoperative course. J Foot Ankle Surg. 2007;46(4):248–55.

    Article  PubMed  Google Scholar 

  78. Dalla Paola L, Carone A, Boscarino G, Scavone G, Vasilache L. Combination of open subtotal calcanectomy and stabilization with external fixation as limb salvage procedure in hindfoot-infected diabetic foot ulcers. Int J Low Extrem Wounds. 2016;15(4):332–7.

    Article  PubMed  Google Scholar 

  79. Drampalos E, Mohammad HR, Kosmidis C, Balal M, Wong J, Pillai A. Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: the Silo technique. Foot. 2018;34:40–4.

    Article  PubMed  Google Scholar 

  80. Phyo N, Tang W, Kavarthapu V. Medium-term outcomes of multi-disciplinary surgical management of non-ischemic diabetic heel ulcers. J Clin Orthop Trauma. 2021;17:30–6. https://doi.org/10.1016/j.jcot.2021.01.012.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Stravinskas M, Horstmann P, Ferguson J, Hettwer W, Nilsson M, Tarasevicius S, Petersen MM, McNally MA, Lidgren L. Pharmacokinetics of gentamicin eluted from a regenerating bone graft substitute: in vitro and clinical release studies. Bone Jt Res. 2016;5:427–35.

    Article  CAS  Google Scholar 

  82. Colding-Rasmussen T, Horstmann P, Petersen MM, Hettwer W. Antibiotic elution characteristics and pharmacokinetics of gentamicin and vancomycin from a mineral antibiotic carrier: an in vivo evaluation of 32 clinical cases. J Bone Jt Infect. 2018;3:234–40.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Vas PRJ, Edmonds M, Kavarthapu V, et al. The diabetic foot attack: “tis too late to retreat!”. Int J Low Extrem Wounds. 2018;17(1):7–13.

    Article  PubMed  Google Scholar 

  84. Vainieri E, Ahluwalia R, Slim H, et al. Outcomes after emergency admission with a diabetic foot attack indicate a high rate of healing and limb salvage but increased mortality: 18-month follow-up study. Exp Clin Endocrinol Diabetes. 2020;130:165. https://doi.org/10.1055/a-1322-4811.

    Article  CAS  PubMed  Google Scholar 

  85. Bateman AH, Bradford S, Hester TW, et al. Modern orthopedic inpatient care of the orthopedic patient with diabetic foot disease. Int J Low Extrem Wounds. 2015;14(4):384–92.

    Article  PubMed  Google Scholar 

  86. Frykberg RG, Attinger C, Smeets L, Koller A, Bal A, Kavarthapu V. Surgical strategies for prevention of amputation of the diabetic foot. J Clin Orthop Trauma. 2021;17:99–105. https://doi.org/10.1016/j.jcot.2021.02.019.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Kavarthapu V, Budair B. Two-stage reconstruction of infected Charcot foot using internal fixation. Bone Jt J. 2021;103-B:10:1611–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. King’s College Hospital, London, UK

    Venu Kavarthapu

  2. Department of Surgery and Diabetic Foot Unit, Hospital La Paloma, Las Palmas de Gran Canaria, Spain

    Javier Aragón Sánchez

Authors
  1. Venu Kavarthapu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Aragón Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Venu Kavarthapu .

Editor information

Editors and Affiliations

  1. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    Christopher E. Attinger

  2. Department of Plastic Surgery, Georgetown University School of Medicine and MedStar Georgetown University Hospital, Washington, DC, USA

    John S. Steinberg

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kavarthapu, V., Sánchez, J.A. (2023). Surgical Management of Diabetic Foot Infection and Osteomyelitis. In: Attinger, C.E., Steinberg, J.S. (eds) Functional Limb Salvage. Springer, Cham. https://doi.org/10.1007/978-3-031-27725-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-27725-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-27724-5

  • Online ISBN: 978-3-031-27725-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation