APMA Conference Coverage

Early Surgery Improves Outcomes in Diabetic Foot Ulcers with Osteomyelitis

Anthony Calabro, MA

Key Highlights

  • Early surgical intervention halved average healing time (8 weeks vs 16 weeks).
  • Infection resolution reached 90% in the surgical group vs 75% in the nonoperative group.
  • Amputation rates were significantly lower with early surgery (5% vs 15%).
  • Patients who underwent surgery experienced shorter hospital stays and lower recurrence rates.

A retrospective analysis comparing early surgical intervention with nonoperative treatment for diabetic foot ulcers (DFUs) complicated by osteomyelitis found that patients undergoing surgery had markedly better outcomes, including significantly faster wound healing, higher infection resolution rates, shorter hospital stays, and a reduced incidence of amputations compared with patients managed nonoperatively through antibiotics and wound care. Researchers presented their findings at the American Podiatric Medical Association 2025 Annual Scientific Meeting in Dallas/Fort Worth, TX.

DFUs remain a major source of morbidity in patients with diabetes, especially when complicated by osteomyelitis—a severe bone infection that complicates healing and increases the risk of limb loss. Standard treatment approaches diverge between nonoperative care and early surgical debridement or resection. Given the clinical challenges and patient burden associated with prolonged infections and hospital stays, this study sought to determine which approach leads to superior clinical outcomes.

Investigators conducted a retrospective review of 100 adult patients with type 2 diabetes and radiographically confirmed DFUs with osteomyelitis, treated between January 2018 and December 2023. Patients were assigned to one of two groups: 50 underwent early surgical debridement or bone resection (Group 1), and 50 received conservative management with antibiotics and wound care (Group 2). Key outcomes assessed included time to healing, infection resolution, recurrence, duration of hospitalization, and amputation rates. Statistical comparisons were made using chi-square and independent t-tests, with a P value of < .05 deemed significant.

Patients who received early surgical intervention healed in an average of 8 weeks, compared with 16 weeks for those managed conservatively (P < .05). Infection resolution was achieved in 90% of the surgical group versus 75% of the conservative group. Only 5% of surgical patients required amputation, in contrast with 15% in the conservative group (P < .05). The average hospital stay was also shorter in the surgical cohort (7 days vs 14 days), and infection recurrence within 6 months was lower (10% vs 25%).

While the study’s retrospective design and single-center setting limit generalizability, its findings highlight a clear trend favoring early surgical intervention. The authors note that additional prospective studies with larger samples and longer follow-up periods are needed to assess long-term outcomes and further refine treatment algorithms.

“The findings of this study suggest that early surgical intervention in the management of diabetic foot ulcers complicated by osteomyelitis offers superior outcomes compared to conservative management,” the authors concluded. “Patients who underwent early surgery demonstrated faster healing times, better infection resolution rates, shorter hospital stays, and a lower incidence of amputations.”

Reference
Casimir S, Kirakosian A. Comparative outcomes of early surgical intervention vs conservative management in diabetic foot ulcers with osteomyelitis. Poster presented at: APMA 2025 Annual Scientific Meeting; July 24–27, 2025; Grapevine, TX.