A 65-year-old man with well-controlled diabetes presents with a chronic non-healing ulcer over the plantar aspect of the right foot for 6 weeks. Probe-to-bone test is positive. MRI confirms osteomyelitis of the 5th metatarsal head without extensive soft tissue involvement. What is the most appropriate management?

• A Hyperbaric oxygen therapy combined with antibiotics
• B Below-knee amputation
• C Ray amputation of the 5th toe with adequate margins
• D 6 weeks of targeted antibiotic therapy alone ✓

Explanation

For diabetic foot osteomyelitis limited to the forefoot without extensive soft tissue compromise or gangrene, 6 weeks of targeted antibiotic therapy without surgical resection is appropriate. Surgical amputation is reserved for cases with extensive necrosis, gangrene, or failed antibiotic therapy. The IDSA guidelines support antibiotic-only treatment for uncomplicated forefoot osteomyelitis with good soft tissue cover.

Reference: Levin and O'Neal's The Diabetic Foot, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.