Oral antibiotic therapy in diabetic foot osteomyelitis: one small step or a giant leap of faith?

One in 3 subjects with diabetes may experience foot ulcers during their lifetime. Over half of such ulcerations are complicated by infection (1), often involving bones as well. It is estimated that a degree of diabetic foot osteomyelitis (DFO) may affect 20–60% of all infected diabetic foot ulcers (2). The presence of DFO is associated with significantly poor clinical outcomes, including slower time to healing, longer duration of hospitalisation and a higher likelihood of amputation (3). The presentation of DFO can often be insidious. Indeed, the typical features of axial bone and joint infections, such as pain and localised erythema, can often be absent or subtle. Thus, detection and management of DFO remains one of the most challenging and debated facets of diabetic foot care (2,3).