{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:59:53Z","timestamp":1777712393904,"version":"3.51.4"},"reference-count":22,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>Diabetes-related foot osteomyelitis (DFO) can present as an acute condition with soft tissue involvement or as a non-acute form characterized by long-standing ulcers without immediate limb-threatening features. This study evaluates infection relapse and healing times after conservative surgery in non-acute DFO, with a focus on osteomyelitis localization. A retrospective cohort of 60 patients treated for forefoot DFO without soft tissue involvement or necrosis was analyzed. Conservative surgery, defined as resection of infected bone without amputation, was performed in all cases. Postoperative antibiotic therapy was guided by bone biopsy cultures. Infection relapse was defined as new evidence of infection localized to the previously treated bone. Infection arrest was achieved in 98.3% of cases, with a recurrence rate of 10%. Relapse was significantly associated with osteomyelitis localized to the first metatarsal head, which presented a 57.1% relapse rate compared to 3.8% in other locations (OR: 34.0, 95% CI: 4.34\u2013266, p\u2009&lt;\u20090.001). Healing times were longer for the first metatarsal head, first toe, and second to fifth metatarsal heads compared to the lesser toes, but the association with the first metatarsal head lost significance when relapse was included in the analysis. This study highlights the effectiveness of conservative surgery in non-acute DFO, achieving high healing rates while preserving limb function. The findings emphasize the critical role of osteomyelitis localization, particularly the first metatarsal head, in determining relapse and healing outcomes. These results provide a basis for future research into individualized surgical strategies for high-risk anatomical sites.<\/jats:p>","DOI":"10.1177\/15347346241312442","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T03:21:27Z","timestamp":1736306487000},"page":"41-50","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Infection Relapse and Time-to-Healing After Conservative Surgery for Non-Acute Presentations of Diabetes-Related Forefoot Osteomyelitis: Does Site Matter?"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-5040","authenticated-orcid":false,"given":"Javier","family":"Arag\u00f3n-S\u00e1nchez","sequence":"first","affiliation":[{"name":"Department of Surgery, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0028-765X","authenticated-orcid":false,"given":"Gerardo","family":"V\u00edquez-Molina","sequence":"additional","affiliation":[{"name":"Diabetic foot Unit, San Juan de Dios Hospital, San Jos\u00e9 de Costa Rica, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Arag\u00f3n-Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Orthopaedic and Traumatology Surgery, Dr Negr\u00edn University Hospital, Las Palmas de Gran Canaria, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Mar\u00eda","family":"Rojas-Bonilla","sequence":"additional","affiliation":[{"name":"Diabetic foot Unit, San Juan de Dios Hospital, San Jos\u00e9 de Costa Rica, Costa Rica"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734612447617"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3687"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-008-1131-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.7547\/20-147"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/1534734613502033"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2010.03150.x"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193146"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12202"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13439"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.13861"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.19.11.1257"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-1526"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03528.x"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2023-003611"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.7547\/16-143"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3165"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.70072"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.13215"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2014.08.004"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2010.0973"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.7547\/87507315-81-4-167"},{"issue":"9911072","key":"e_1_3_2_23_2","article-title":"Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial","volume":"2021","author":"Mendame Ehya RE","year":"2021","unstructured":"Mendame Ehya RE, Zhang H, Qi B, Yu A. Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial. 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