Table 1.

Criteria for selecting primarily antibiotic or surgical approaches for diabetic foot osteomyelitis

Medical

Surgical

Patient too unstable for surgery Poor postoperative mechanics of foot likely (eg, with midfoot or hindfoot infection) No other surgical procedures on foot are needed Infection is confined to small forefoot lesion No adequately skilled surgeon is available Surgery costs are prohibitive for the patient Patient has a strong preference to avoid surgery No hospitalization There are no contraindications to prolonged antibiotic therapy

Foot infection is associated with substantial bone necrosis or exposed joint There is persisting sepsis Foot appears to be functionally unsalvageable Patient is already nonambulatory Major risks of antibiotic problems Infecting pathogen is resistant to available antibiotics Uncorrectable foot ischemia, patient has a strong preference for surgical treatment Hospitalization

Note: Data from Lipsky et al⁹ and Senneville and Robineau.³⁷