Heel Diabetic Foot Osteomyelitis: A Current Challenge in the Clinical Practice
Summary: This retrospective observational study assessed outcomes of patients with diabetic foot osteomyelitis (DFO) managed in a specialized diabetic foot service between 2019 and 2022. Researchers compared patients with heel DFO to those with forefoot or midfoot DFO over a one-year follow-up, examining healing rates, healing time, amputation, and mortality.
Findings: Among 114 patients (mean age 67.9 years, 72.8% male, 91.2% type 2 diabetes), 30 had heel DFO and 84 had forefoot/midfoot DFO. Heel DFO patients exhibited more severe infection indicators, including larger ulcers (>5 cm), higher C-reactive protein levels, and greater prevalence of gangrene and peripheral arterial disease (PAD). Healing outcomes were significantly poorer for heel DFO cases, with longer healing times and higher rates of major amputation.
- Healing rate: 66.7% (heel) vs 97% (forefoot/midfoot)
- Healing time: 14 ± 6 weeks (heel) vs 6.8 ± 5 weeks (forefoot/midfoot)
- Major amputation: 10% (heel) vs 0% (forefoot/midfoot)
- Mortality: 6.6% (heel) vs 4.8% (forefoot/midfoot)
Multivariate analysis identified heel DFO and PAD as independent predictors of major amputation and non-healing. The study concludes that heel DFO represents a distinct clinical challenge associated with worse prognosis and slower recovery compared to other DFO sites.
Keywords:
diabetic foot osteomyelitis,
heel ulcer,
diabetic foot ulcer,
amputation risk,
peripheral arterial disease