{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:55:18Z","timestamp":1780343718714,"version":"3.54.1"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"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"],"abstract":"<jats:p>The current study aimed to evaluate the outcomes of heel diabetic foot osteomyelitis (DFO) managed in a specialized diabetic foot service. The research is a single-center retrospective observational study including a population of patients with diabetic foot ulcers (DFUs) complicated by DFO and requiring hospitalization, managed between 2019 and 2022 in a tertiary level diabetic foot service. According to the location of bone infection, patients were divided into two groups: those with heel DFO and those with forefoot\/midfoot DFO. After one year of follow-up, the following outcomes were evaluated and compared between groups: healing, healing time, major amputation, and mortality.<\/jats:p>\n                  <jats:p>Overall, 114 patients were included. The mean age was 67.9\u2009\u00b1\u200912, most of them were male (72.8%) and had type 2 diabetes (91.2%); 84 (73.7%) of patients reported forefoot\/midfoot DFO, while 30 (26.3%) reported heel DFO. Patients with heel DFO showed greater rates of soft tissue infection (80 vs 68.7%, p\u2009=\u20090.04), ulcer size &gt;5 cm (93.3 vs 34.3%, p\u2009=\u2009&lt;0.0001), gangrene (63.3 vs 22.9%, p\u2009=\u2009&lt;0.0001), higher C-reactive protein values (67.6\u2009\u00b1\u200925 vs 24\u2009\u00b1\u200916 mg\/dl, p\u2009=\u20090.0002) and concomitant peripheral arterial disease (PAD) (83.3 vs 52.4%, p\u2009=\u20090.0002).<\/jats:p>\n                  <jats:p>Outcomes for heel DFO and forefoot\/midfoot DFO were: wound healing (66.7 vs 97%, p\u2009=\u2009&lt;0.0001), healing time (14\u2009\u00b1\u20096 vs 6.8\u2009\u00b1\u20095 weeks, p=&lt;0.0001), major amputation (10 vs 0%, p\u2009=\u20090.0002), and mortality (6.6 vs 4.8%, p\u2009=\u20090.3) respectively. At the multivariate logistic regression analysis, heel DFO [OR 8.4, CI95% (2.1\u201314.8), p=&lt;0.0001] and PAD [OR 3.5, CI95% (1.1\u20134.2), p\u2009=\u20090.001] were independent predictors of major amputation, while heel DFO [OR 6.8, CI95% (1.9\u201310.5), p=&lt;0.0001], PAD [OR 4.8, CI95% (1.4\u20137.6), p\u2009=\u20090.0001], and ulcer size [OR 1.5, CI95% (1.2\u20132.6), p=&lt;0.0001] were independent predictors of non-healing.<\/jats:p>\n                  <jats:p>Heel DFO resulted associated with a higher risk of major amputation and reduced chance of healing.<\/jats:p>","DOI":"10.1177\/15347346251376115","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T18:30:48Z","timestamp":1759170648000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Heel Diabetic Foot Osteomyelitis: A Current Challenge in the Clinical Practice"],"prefix":"10.1177","author":[{"given":"Martina","family":"Salvi","sequence":"first","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico Rolando","family":"Bonanni","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Uccioli","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetes, Department of Systems Medicine, CTO Andrea Alesini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermanno","family":"Bellizzi","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Ruotolo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Andreadi","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Bellia","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Lauro","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-9622","authenticated-orcid":false,"given":"Marco","family":"Meloni","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"},{"name":"Division of Endocrinology and Diabetology, Department of Medical Sciences, University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3687"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabet.2007.09.005"},{"key":"e_1_3_3_4_2","unstructured":"Boulton AJM Whitehouse RW. 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