Therapeutic options and prognostic risk factors in diabetic foot osteomyelitis: a narrative review

Diabetic foot osteomyelitis (DFO) is a severe diabetic foot complication characterized by deep tissue and bone infection, frequently requiring complex treatment and carrying a high risk of amputation. This review summarizes recent advances in pharmacological and surgical treatments and highlights key prognostic factors affecting patient outcomes. Emerging antimicrobial agents such as dalbavancin, tedizolid, and novel cephalosporins, alongside bacteriophage therapy and immunomodulatory strategies like granulocyte colony-stimulating factor (G-CSF), show promise in improving infection management. Advanced local drug delivery systems, including antibiotic-loaded bioactive materials and nanotechnology-based carriers, enhance drug efficacy while reducing systemic side effects. Surgical approaches emphasize limb-salvage techniques with targeted bone resection, revascularization procedures, and soft-tissue reconstruction. Amputation should be carefully evaluated and reserved for extensive infection or irreversible ischemia. Prognosis heavily depends on glycemic control, renal function, immune status, and cardiovascular health. Comprehensive multidisciplinary management is crucial to improving patient outcomes, reducing amputations, and enhancing quality of life.