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). Tissue cultures sampled from the wound grew Proteus mirabilis. We treated the patient for osteomyelitis of the great toe with intravenous piperacillin–tazobactam (4·5 g every 8 h for 3 weeks), followed by oral ciprofloxacin (500 mg every 12 h for 9 weeks).