An Orthopaedist's Review of Diabetic Foot Wounds and Osteomyelitis

Matthew R. DeSanto, BS; Luke V. Weber, BS; Emmanuel Nageeb, BS; Kyle Petersen, MD; Jeffrey Junko, MD


Curr Orthop Pract. 2020;31(5):423-428. 

In This Article

Abstract and Introduction


As the number of patients with diabetes continues to grow, complications of diabetes have likewise increased. Specifically, diabetic foot ulcers have become a massive burden to both the diabetic patient population and national healthcare systems. Diabetic foot ulcers occur due to nerve damage as a result of extensive hyperglycemia. This nerve damage can allow the progression of ulceration, thus providing a window of opportunity for various pathogens to invade the surrounding tissue. Extensive infection of the ulcer tissue can lead to infection of nearby bone, which may require both surgical and antimicrobial intervention for proper wound healing. The aim of this review was to describe the etiology, pathological progressions, and the advancement of ideologies pertaining to treatment options for diabetic foot ulcers.


Marchal de Calvi[1] first proposed the relationship of diabetes and coinciding foot ulcers in 1852, consequently establishing the term diabetic foot ulcer. Shortly after, Thomas Hodgkin[2] proceeded to discuss the correlation between diabetes and gangrene in 1854. In the 1880s, Frederick Treves[3] explored treatment potentiality through sharp debridement of calluses. These efforts helped develop several therapeutic principles, such as sharp debridement, off-loading, and patient education, that remain implemented in current practices.[4]

In more recent times, the number of patients with diabetes has continued to grow in relation to the ongoing obesity epidemic. It is estimated that nearly 425 million suffer from diabetes mellitus (DM) globally, with this number anticipated to elevate to 629 million by 2045.[5] Furthermore, the lifetime risk for an individual diagnosed with diabetes developing a diabetic foot ulcers is 25%.[6] Given these statistics, it can reasonably be approximated that nearly 160 million people could be affected by diabetic foot ulcers in 2045. This will put a significant global burden on an already stressed health care system. Estimation of burden, quantitatively, is that 20% of total expenditure regarding diabetes, specifically in North America and Europe, may be attributable to diabetic foot ulcers.[7] The average cost of diabetic foot ulcer treatment ranges from $1892 to $33,500[8,9] per episode of care and is highest in patients with concomitant peripheral arterial disease.[10] Most importantly, the five year mortality of a patient with diabetic foot ulcers is roughly 50%, and this rate is even higher among those with recent amputation.[11]