{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:51:56Z","timestamp":1787068316294,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"\n Background<\/jats:title>\n The preferred primary treatment of toe osteomyelitis in diabetic patients is controversial. We compared the outcome of primary nonoperative antibiotic treatment versus digital amputation in patients with diabetes-related chronic digital osteomyelitis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective medical record review of patients treated for digital osteomyelitis at a single center. Patients were divided into two groups according to initial treatment: 1) nonoperative treatment with intravenous antibiotics and 2) amputation of the involved toe or ray. Duration of hospitalization, number of rehospitalizations, and rate of below- or above-the-knee major amputations were evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The nonoperative group comprised 39 patients and the operative group included 21 patients. The mean \u00b1 SD total duration of hospitalization was 24.05 \u00b1 15.43 and 20.67 \u00b1 15.97 days, respectively (\n P<\/jats:italic>\n = .43). The mean \u00b1 SD number of rehospitalizations after infection recurrence was 2.62 \u00b1 1.63 and 1.67 \u00b1 1.24, respectively (\n P<\/jats:italic>\n = .02). During follow-up, the involved digit was eventually amputated in 13 of the 39 nonoperatively treated patients (33.3%). The rate of major amputation (above- or below-knee amputation was four of 39 (10.3%) and three of 21 (14.3%), respectively (\n P<\/jats:italic>\n = .69).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Despite a higher rate of rehospitalizations and a high failure rate, in patients with mild and limited digital foot osteomyelitis in the absence of sepsis it may be reasonable to offer a primary nonoperative treatment for digital osteomyelitis of the foot.<\/jats:p>\n <\/jats:sec>","DOI":"10.7547\/19-155","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T16:02:19Z","timestamp":1630684939000},"source":"Crossref","is-referenced-by-count":8,"title":["Amputation versus Primary Nonoperative Management of Chronic Osteomyelitis Involving a Pedal Digit in Diabetic Patients"],"prefix":"10.3390","volume":"111","author":[{"given":"Viktor","family":"Feldman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Segal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Atzmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itai","family":"Ron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meir","family":"Nyska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nissim","family":"Ohana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel","family":"Palmanovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-111-4-Article_2-b01","series-title":"The High Risk Foot in Diabetes Mellitus,","first-page":"197","article-title":"\u201cDiabetic Foot Infections,\u201d","author":"Sapico","year":"1991","unstructured":"Sapico\n FL\n \n \n Bessman\n AN:\n \n \n \u201cDiabetic Foot Infections,\u201d\n in\n \n The High Risk Foot in Diabetes Mellitus,\n \n edited by\n \n \n Fryberg,\n RG\n \n \n p\n 197,\n\t\t\t\t\tChurchill Livingstone,\n\t\t\t\t\tNew York,\n\t\t\t\t\t1991."},{"key":"i8750-7315-111-4-Article_2-b02","series-title":"Int J Low Extrem Wounds","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1177\/1534734614554282","article-title":"Difficult situations managing diabetic foot: evidences and personal views: is to operate on patients with diabetic foot osteomyelitis old-fashioned?","volume":"13","author":"Senneville","year":"2014","unstructured":"Senneville\n E\n \n \n Nguyen\n S:\n \n \n Difficult situations managing diabetic foot: evidences and personal views: is to operate on patients with diabetic foot osteomyelitis old-fashioned?\n Int J Low Extrem Wounds\n 13: \n\t\t\t\t\t241,\n\t\t\t\t\t2014.\n\t\t\t\t2538491410.1177\/1534734614554282"},{"key":"i8750-7315-111-4-Article_2-b03","series-title":"Diabetes Metab","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.diabet.2007.09.005","article-title":"Diabetic foot osteomyelitis","volume":"34","author":"Hartemann-Heurtier","year":"2008","unstructured":"Hartemann-Heurtier\n A\n \n \n Senneville\n E:\n \n \n Diabetic foot osteomyelitis.\n\t\t\t\t\tDiabetes Metab34: \n\t\t\t\t\t87,\n\t\t\t\t\t2008.\n\t\t\t\t1824211410.1016\/j.diabet.2007.09.005"},{"key":"i8750-7315-111-4-Article_2-b04","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1086\/498112","article-title":"Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures","volume":"42","author":"Senneville","year":"2006","unstructured":"Senneville\n E\n \n \n Melliez\n H\n \n \n Beltrand\n E\n \n :\n\t\t\t\t\t\n Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures.\n\t\t\t\t\tClin Infect Dis42: \n\t\t\t\t\t57,\n\t\t\t\t\t2006.\n\t\t\t\t1632309210.1086\/498112"},{"key":"i8750-7315-111-4-Article_2-b05","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.2337\/diacare.19.11.1257","article-title":"Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery","volume":"19","author":"Ha Van","year":"1996","unstructured":"Ha Van\n G\n \n \n Siney\n H\n \n \n Danan\n JP\n \n :\n\t\t\t\t\t\n Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery.\n\t\t\t\t\tDiabetes Care19: \n\t\t\t\t\t1257,\n\t\t\t\t\t1996.\n\t\t\t\t890839010.2337\/diacare.19.11.1257"},{"key":"i8750-7315-111-4-Article_2-b06","series-title":"Arch Intern Med","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1001\/archinte.159.8.851","article-title":"Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up","volume":"159","author":"Pittet","year":"1999","unstructured":"Pittet\n D\n \n \n Wyssa\n B\n \n \n Herter-Clavel\n C\n \n :\n\t\t\t\t\t\n Outcome of diabetic foot infections treated conservatively: a retrospective cohort study with long-term follow-up.\n\t\t\t\t\tArch Intern Med159: \n\t\t\t\t\t851,\n\t\t\t\t\t1999.\n\t\t\t\t1021993110.1001\/archinte.159.8.851"},{"key":"i8750-7315-111-4-Article_2-b07","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/S0741-5214(99)70078-9","article-title":"Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status","volume":"30","author":"Nehler","year":"1999","unstructured":"Nehler\n MR\n \n \n Whitehill\n TA\n \n \n Bowers\n SP\n \n :\n\t\t\t\t\t\n Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status.\n\t\t\t\t\tJ Vasc Surg30: \n\t\t\t\t\t509,\n\t\t\t\t\t1999.\n\t\t\t\t1047764410.1016\/S0741-5214(99)70078-9"},{"key":"i8750-7315-111-4-Article_2-b08","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1093\/clinids\/23.2.286","article-title":"Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation?","volume":"23","author":"Tan","year":"1996","unstructured":"Tan\n JS\n \n \n Friedman\n NM\n \n \n Hazelton-Miller\n C\n \n :\n\t\t\t\t\t\n Can aggressive treatment of diabetic foot infections reduce the need for above-ankle amputation?\n Clin Infect Dis\n 23: \n\t\t\t\t\t286,\n\t\t\t\t\t1996.\n\t\t\t\t10.1093\/clinids\/23.2.2868842265"},{"key":"i8750-7315-111-4-Article_2-b09","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/0002-9343(87)90894-1","article-title":"Osteomyelitis in the feet of diabetic patients: long-term results, prognostic factors, and the role of antimicrobial and surgical therapy","volume":"83","author":"Bamberger","year":"1987","unstructured":"Bamberger\n DM\n \n \n Daus\n GP\n \n \n Gerding\n DN:\n \n \n Osteomyelitis in the feet of diabetic patients: long-term results, prognostic factors, and the role of antimicrobial and surgical therapy.\n\t\t\t\t\tAm J Med83: \n\t\t\t\t\t653,\n\t\t\t\t\t1987.\n\t\t\t\t10.1016\/0002-9343(87)90894-13499821"},{"key":"i8750-7315-111-4-Article_2-b10","series-title":"Diabet Foot","first-page":"76","article-title":"The management of diabetic foot osteomyelitis","volume":"3","author":"Embil","year":"2000","unstructured":"Embil\n J:\n \n \n The management of diabetic foot osteomyelitis.\n\t\t\t\t\tDiabet Foot3: \n\t\t\t\t\t76,\n\t\t\t\t\t2000."},{"key":"i8750-7315-111-4-Article_2-b11","series-title":"J Diabetes Complications","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/S1056-8727(99)00065-3","article-title":"Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis","volume":"13","author":"Eneroth","year":"1999","unstructured":"Eneroth\n M\n \n \n Larsson\n J\n \n \n Apelqvist\n J:\n \n \n Deep foot infections in patients with diabetes and foot ulcer: an entity with different characteristics, treatments, and prognosis.\n\t\t\t\t\tJ Diabetes Complications13: \n\t\t\t\t\t254,\n\t\t\t\t\t1999.\n\t\t\t\t1076499910.1016\/S1056-8727(99)00065-3"},{"issue":"(suppl 4A)","key":"i8750-7315-111-4-Article_2-b12","series-title":"Am J Med","first-page":"146","article-title":"Oral ciprofloxacin in the treatment of serious soft tissue and bone infection: efficacy, safety, and pharmacokinetics","volume":"82","author":"Nix","year":"1987","unstructured":"Nix\n DK\n \n \n Cumbo\n TJ\n \n \n Kuritzky\n P\n \n :\n\t\t\t\t\t\n Oral ciprofloxacin in the treatment of serious soft tissue and bone infection: efficacy, safety, and pharmacokinetics.\n\t\t\t\t\tAm J Med82(suppl 4A): 146,\n\t\t\t\t\t1987.\n\t\t\t\t3555029"},{"key":"i8750-7315-111-4-Article_2-b13","series-title":"J Antimicrob Chemother","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1093\/jac\/48.6.927","article-title":"Rifampicin-ofloxacin oral regimen for the treatment of mild to moderate diabetic foot osteomyelitis","volume":"48","author":"Senneville","year":"2001","unstructured":"Senneville\n E\n \n \n Yazdanpanah\n Y\n \n \n Cazaubiel\n M\n \n :\n\t\t\t\t\t\n Rifampicin-ofloxacin oral regimen for the treatment of mild to moderate diabetic foot osteomyelitis.\n\t\t\t\t\tJ Antimicrob Chemother48: \n\t\t\t\t\t927,\n\t\t\t\t\t2001.\n\t\t\t\t10.1093\/jac\/48.6.92711733482"},{"key":"i8750-7315-111-4-Article_2-b14","series-title":"Diabet Med","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1002\/(SICI)1096-9136(199706)14:6<487::AID-DIA373>3.0.CO;2-Q","article-title":"Conservative management of osteomyelitis in the feet of diabetic patients","volume":"14","author":"Venkatesan","year":"1997","unstructured":"Venkatesan\n P\n \n \n Lawn\n S\n \n \n Macfarlane\n RM\n \n :\n\t\t\t\t\t\n Conservative management of osteomyelitis in the feet of diabetic patients.\n\t\t\t\t\tDiabet Med14: \n\t\t\t\t\t487,\n\t\t\t\t\t1997.\n\t\t\t\t921231610.1002\/(SICI)1096-9136(199706)14:6<487::AID-DIA373>3.0.CO;2-Q"},{"key":"i8750-7315-111-4-Article_2-b15","series-title":"Wounds","first-page":"31","article-title":"Conservative management of diabetic foot ulcers complicated by osteomyelitis","volume":"14","author":"Yadlapalli","year":"2002","unstructured":"Yadlapalli\n N\n \n \n Vaishnar\n A\n \n \n Sheehan\n P:\n \n \n Conservative management of diabetic foot ulcers complicated by osteomyelitis.\n\t\t\t\t\tWounds14: \n\t\t\t\t\t31,\n\t\t\t\t\t2002."},{"issue":"(suppl 1)","key":"i8750-7315-111-4-Article_2-b16","series-title":"Diabetes Metab Res Rev","doi-asserted-by":"publisher","first-page":"S145","DOI":"10.1002\/dmrr.836","article-title":"Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment","volume":"24","author":"Berendt","year":"2008","unstructured":"Berendt\n AR\n \n \n Peters\n EJ\n \n \n Bakker\n K\n \n :\n\t\t\t\t\t\n Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment.\n\t\t\t\t\tDiabetes Metab Res Rev24(suppl 1): S145,\n\t\t\t\t\t2008.\n\t\t\t\t10.1002\/dmrr.836"},{"issue":"(suppl 1)","key":"i8750-7315-111-4-Article_2-b17","series-title":"Diabetes Metab Res Rev","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1002\/dmrr.2699","article-title":"International Working Group on the Diabetic Foot: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes","volume":"32","author":"Lipsky","year":"2016","unstructured":"Lipsky\n BA\n \n \n Arag\u00f3n-S\u00e1nchez\n J\n \n \n Diggle\n M\n \n et al;\n \n International Working Group on the Diabetic Foot: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes.\n\t\t\t\t\tDiabetes Metab Res Rev32(suppl 1): 45,\n\t\t\t\t\t2016.\n\t\t\t\t10.1002\/dmrr.2699"},{"key":"i8750-7315-111-4-Article_2-b18","series-title":"Int J Low Extrem Wounds","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1177\/1534734610361949","article-title":"Treatment of diabetic foot osteomyelitis: a surgical critique","volume":"9","author":"Aragon-Sanchez","year":"2010","unstructured":"Aragon-Sanchez\n J:\n \n \n Treatment of diabetic foot osteomyelitis: a surgical critique.\n\t\t\t\t\tInt J Low Extrem Wounds9: \n\t\t\t\t\t37,\n\t\t\t\t\t2010.\n\t\t\t\t10.1177\/153473461036194920207622"},{"key":"i8750-7315-111-4-Article_2-b19","series-title":"J Vasc Interv Radiol","doi-asserted-by":"publisher","first-page":"S31","DOI":"10.1016\/j.jvir.2013.01.481","article-title":"The role of bone biopsy in osteomyelitis: utility or futility?","volume":"24","author":"Mikus","year":"2013","unstructured":"Mikus\n JR\n \n \n Worsham\n J\n \n \n Aung,\n H\n \n :\n\t\t\t\t\t\n The role of bone biopsy in osteomyelitis: utility or futility?\n J Vasc Interv Radiol\n 24: \n\t\t\t\t\tS31,\n\t\t\t\t\t2013.\n\t\t\t\t10.1016\/j.jvir.2013.01.481"},{"key":"i8750-7315-111-4-Article_2-b20","series-title":"Clin Orthop Relat Res","first-page":"192","article-title":"Amputation of the great toe: a clinical and biomechanical study","volume":"226","author":"Mann","year":"1988","unstructured":"Mann\n RA\n \n \n Poppen\n NK\n \n \n O'Konski\n M:\n \n \n Amputation of the great toe: a clinical and biomechanical study.\n\t\t\t\t\tClin Orthop Relat Res226: \n\t\t\t\t\t192,\n\t\t\t\t\t1988."},{"issue":"(suppl 2)","key":"i8750-7315-111-4-Article_2-b21","series-title":"Clin Infect Dis","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1086\/383272","article-title":"Controversies in diagnosing and managing osteomyelitis of the foot in diabetes","volume":"39","author":"Jeffcoate","year":"2004","unstructured":"Jeffcoate\n WJ\n \n \n Lipsky\n BA:\n \n \n Controversies in diagnosing and managing osteomyelitis of the foot in diabetes.\n\t\t\t\t\tClin Infect Dis39(suppl 2): S115,\n\t\t\t\t\t2004.\n\t\t\t\t10.1086\/38327215306989"},{"key":"i8750-7315-111-4-Article_2-b22","series-title":"Diabet Med","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1111\/j.1464-5491.2008.02573.x","article-title":"International Working Group on the Diabetic Foot: Unresolved issues in the management of ulcers of the foot in diabetes","volume":"25","author":"Jeffcoate","year":"2008","unstructured":"Jeffcoate\n WJ\n \n \n Lipsky\n BA\n \n \n Berendt\n AR\n \n et al;\n \n International Working Group on the Diabetic Foot: Unresolved issues in the management of ulcers of the foot in diabetes.\n\t\t\t\t\tDiabet Med25: \n\t\t\t\t\t1380,\n\t\t\t\t\t2008.\n\t\t\t\t10.1111\/j.1464-5491.2008.02573.x"},{"key":"i8750-7315-111-4-Article_2-b23","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1056\/NEJM198008143030703","article-title":"Osteomyelitis: the past decade","volume":"303","author":"Waldvogel","year":"1980","unstructured":"Waldvogel\n FA\n \n \n Papageorgiou\n PS:\n \n \n Osteomyelitis: the past decade.\n\t\t\t\t\tN Engl J Med303: \n\t\t\t\t\t360,\n\t\t\t\t\t1980.\n\t\t\t\t10.1056\/NEJM1980081430307036993944"},{"key":"i8750-7315-111-4-Article_2-b24","series-title":"Curr Opin Infect Dis","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1097\/00001432-200312000-00006","article-title":"Development of drugs for antimicrobial-resistant pathogens","volume":"16","author":"Powers","year":"2003","unstructured":"Powers\n JH:\n \n \n Development of drugs for antimicrobial-resistant pathogens.\n\t\t\t\t\tCurr Opin Infect Dis16: \n\t\t\t\t\t547,\n\t\t\t\t\t2003.\n\t\t\t\t10.1097\/00001432-200312000-0000614624104"},{"key":"i8750-7315-111-4-Article_2-b25","series-title":"Expert Rev Anti Infect Ther","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1080\/14787210.2018.1417037","article-title":"Modern management of diabetic foot osteomyelitis: the when, how and why of conservative approaches","volume":"16","author":"Arag\u00f3n-S\u00e1nchez","year":"2018","unstructured":"Arag\u00f3n-S\u00e1nchez\n J\n \n \n Lipsky\n BA:\n \n \n Modern management of diabetic foot osteomyelitis: the when, how and why of conservative approaches.\n\t\t\t\t\tExpert Rev Anti Infect Ther16: \n\t\t\t\t\t35,\n\t\t\t\t\t2018.\n\t\t\t\t10.1080\/14787210.2018.141703729231774"},{"key":"i8750-7315-111-4-Article_2-b26","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"789","DOI":"10.2337\/dc13-1526","article-title":"Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial","volume":"37","author":"L\u00e1zaro-Mart\u00ednez","year":"2014","unstructured":"L\u00e1zaro-Mart\u00ednez\n J\n \n \n Arag\u00f3n-S\u00e1nchez\n J\n \n \n Garc\u00eda-Morales\n E:\n \n \n Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial.\n\t\t\t\t\tDiabetes Care37: \n\t\t\t\t\t789,\n\t\t\t\t\t2014.\n\t\t\t\t2413034710.2337\/dc13-1526"}],"container-title":["Journal of the American Podiatric Medical 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