Non-surgical treatment of diabetic foot osteomyelitis

A 68-year-old man with well controlled type 2 diabetes presented to the GATA Haydarpasa Teaching Hospital with a swollen red toe (figure A). He had a longstanding plantar ulcer on his first metatarsal. Examination of his foot revealed complete loss of sensation, although pulse palpation and Doppler ultrasound findings were normal. Findings did not suggest a systemic infection or metabolic instability. Serum C-reactive protein (CRP) concentration (111 mg/L) and erythrocyte sedimentation rate (ESR; 89 mm/h) were very high, and plain radiographs showed disrupted cortex and lytic lesions of the first proximal phalanx and metatarsal head (figure E).