Bone Substitute in Diabetic Foot Osteomyelitis Treatment

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Background: Diabetic foot osteomyelitis (DFO) constitutes a severe and prevalent complication of diabetes mellitus (DM). Individuals afflicted with DM exhibit an elevated risk for DFO development, attributable to a confluence of factors, including peripheral neuropathy, compromised circulation, and impaired immune function. Timely diagnosis and appropriate therapeutic intervention are paramount. In recent years, alongside the ablative approach, the feasibility of substituting compromised bone with a bone substitute has emerged. Methods: We retrospectively analyzed resorbable bone grafting procedures performed at our third-level center for the care of people with diabetes between 2019 and 2024. Forty-nine patients were included in this. The median follow-up period was 13 months (Q1 7, Q3 20). Results: At follow-up, 34 patients (69%) had achieved healing, with a median healing time of 2.3 months (Q1 1.5, Q3 5). Lesion location significantly influenced healing outcomes, with forefoot and midfoot lesions demonstrating an 86% healing rate compared to 50% for hindfoot lesions. Eleven patients (22%) experienced infectious relapse after a median of 1 month (Q1 0.7, Q3 2.9). An analysis of different bone substitutes did not reveal significant differences in terms of healing among the various products and between the presence or absence of a local antibiotic. Conclusions: Bone substitute implantation offers an additional conservative strategy for managing DFO. Healing rates are significantly higher for forefoot and midfoot lesions, suggesting that further research is needed to improve outcomes in hindfoot osteomyelitis. Selection of the most effective bone substitute requires further studies.

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