Lower extremity outcomes in diabetic foot osteomyelitis: A systematic review and meta-analysis

Diabetic foot osteomyelitis (DFO) is challenging to treat and often portends a poor prognosis.

The aim of the systematic review was to characterize DFO treatment protocols and meta-analyze the wound healing time, amputations (minor or major), and mortality in people with diabetes with DFO.

A systematic search was conducted across multiple databases including PubMed, SCOPUS, and Google Scholar using MeSH terms “Diabetic foot ulcers,” “Foot osteomyelitis,” “DFO,” “Bone infection AND Diabetes,” “complication of foot osteomyelitis,” “amputation” AND “mortality.” We aimed to identify the DFO outcomes from the prior studies in terms of wound healing or amputation and mortality using a random-effects meta-analysis, presented as pooled proportions with 95% confidence intervals. Heterogeneity was evaluated using Cochran Q, I², τ², and τ.

A total of 110 articles were identified and 9 studies met the inclusion criteria, which were analyzed in the systematic review and meta-analysis. The included studies involved 1499 patients with a mean age of 65.94 ± 1.50 years and a wound duration of 105.3 ± 51.25 days. Forefoot bone infections (89%) were most common. Varied diagnostic modalities were utilized to confirm the diagnosis of DFO. Only three studies utilized bone culture and a single study utilized histopathology of the bones to confirm DFO. Antibiotic duration varied from 6 to 24 weeks along with surgical removal of infected bones in the reviewed studies. Wound healing time averaged 105 days (range 45–182 days) with a 15% recurrence rate. Minor amputations occurred in 47% and major amputations in 29.6%. Overall, 11.9% (range 2%–28.5%) of patients had mortality with DFO. In contrast, sensitivity analysis revealed substantial instability in the pooled amputation rates, indicating they represent indicative ranges rather than precise estimates.

Forefoot DFO is more prevalent with better limb salvage than hindfoot DFO. Individualized treatment approaches were responsible for wide variations in lower limb amputation rates following DFO.