Journal of Osteoporosis and Physical Activity
Open Access

Treating Bone Infections in Diabetic Feet and Ankles

Franklin Labat^{* *}Correspondence: Franklin Labat, Department of Drugs and Medicines, Federal University of Rio de Janeiro, Brazil, Email:

Author info »

Description

Osteomyelitis, an infection of the bone, is a serious complication that can occur in individuals with diabetes, particularly affecting the foot and ankle. Diabetic foot and ankle osteomyelitis is often a consequence of diabetic foot ulcers, where chronic wounds expose the bone to bacterial infection. The management of this condition is challenging and typically requires a multidisciplinary approach. Surgical treatment plays an important role in managing diabetic foot and ankle osteomyelitis, especially when conservative measures fail or the infection is extensive. Diabetes can lead to peripheral neuropathy and peripheral vascular disease, both of which increase the risk of foot ulcers. These ulcers can become infected and, if not properly managed, the infection can spread to the underlying bone, resulting in osteomyelitis. Symptoms may include localized pain, swelling, redness, and drainage from the ulcer. However, in diabetic patients, these symptoms can be less pronounced due to neuropathy, making the condition difficult to diagnose early.

Indications for surgical treatment and techniques

When antibiotics and other non-surgical treatments fail to resolve the infection, surgery may be necessary to remove infected and necrotic bone. Necrotic tissue or abscesses in the affected area can harbor bacteria and perpetuate the infection, making surgical debridement essential. In cases where infection leads to significant bone destruction or deformity, surgery may be required to stabilize the foot or ankle, prevent further damage, and preserve function. If the infection spreads to the bloodstream or causes systemic symptoms, urgent surgical intervention may be necessary to control the source of infection. The choice of surgical technique depends on the extent of the infection, the patient’s overall health, and the specific anatomical location involved. Common surgical approaches include, debridement involves the surgical removal of necrotic tissue, infected bone, and any foreign material. This procedure aims to reduce the bacterial load and promote healing. It may be done under local or general anaesthesia, depending on the extent of the infection and patient tolerance. In cases where infection is limited to a specific area, partial resection of the affected bone can be performed. However, if the infection is extensive, a more radical approach, such as amputation of a toe or part of the foot, may be necessary to prevent the spread of infection. After debridement or resection, reconstructive surgery may be needed to restore foot function and stability. This can involve bone grafting, the use of external fixation devices, or other orthopedic procedures. In severe cases where infection is widespread or life-threatening, amputation may be the only viable option. The goal is to remove the infected tissue while preserving as much function as possible.

Postoperative care and rehabilitation

Proper wound care is essential to prevent new infections and promote healing. This may involve regular dressing changes, monitoring for signs of infection, and managing any drainage. Long-term antibiotic therapy is often required to ensure complete eradication of the infection. The choice of antibiotics is guided by culture and sensitivity results. Patients may need specialized footwear, orthotics, or assistive devices to offload pressure from the affected area and aid in mobility during recovery. Good glycemic control is important to support immune function and wound healing. Physical therapy can help restore strength, balance, and mobility, and is particularly important after reconstructive surgery or amputation.

Conclusion

Surgical treatment of diabetic foot and ankle osteomyelitis is an important component of comprehensive care for diabetic patients with this condition. The primary goals are to eradicate infection, preserve limb function, and prevent recurrence. Early diagnosis, timely surgical intervention, and appropriate postoperative care are essential for improving outcomes and quality of life for patients with diabetic foot and ankle osteomyelitis. Close collaboration among healthcare professionals, including surgeons, endocrinologists, infectious disease specialists, and wound care experts, is necessary to achieve optimal results.