On diabetic foot, wound healing, amputation prevention, and the merger of consumer tech with medical devices
A new systematic review and meta-analysis from Lavery, Wukich, Peters and team asks whether pre-biopsy antibiotics actually reduce bacterial culture yield in suspected diabetic foot osteomyelitis. Spoiler: maybe not.
Senneville and Lipsky return with a measured rejoinder in Clinical Infectious Diseases (April 2026), arguing that the Lagrand trial shows the absence of evidence of superiority — not definitive equivalence — between ulcer-bed and bone biopsy for guiding antibiotic therapy in diabetic foot osteomyelitis.
Our colleagues Larry Lavery and Andrew Crisologo, alongside lead author Orhan Öz, have published a significant prospective study in Diabetologia. Their work tackles one of the most difficult challenges in limb preservation: accurately diagnosing diabetic foot osteomyelitis (DFO) and, crucially, knowing when the infection is actually gone. The Challenge of the "Gold Standard" While bone... Continue Reading →
Exciting new data from our friend and colleague Ben Lipsky and his team highlights a potential shift in how we approach one of our most stubborn challenges: Staphylococcus aureus (StA) in diabetic foot osteomyelitis (DFO). Current standards of care for DFO are often unsatisfactory. This Phase 2, randomized, double-blind, placebo-controlled trial investigated BX211, a personalized... Continue Reading →
Friends, we have some serious dogma-busting data to discuss today. For as long as most of us have been in the limb salvage game, the percutaneous bone biopsy has been preached as the absolute "Gold Standard" for guiding antibiotic therapy in Diabetic Foot Osteomyelitis (DFO). The logic was sound: if you want to know what’s... Continue Reading →
Treating Diabetic Foot Osteomyelitis (DFO) in the forefoot is a daily battle in the trenches of limb preservation. It is the most common location for DFU, DFI, and DFO, occurring in up to 90% of cases. While we often lean on conservative standard care, it frequently fails when the bone is involved. Our colleagues in... Continue Reading →
A newly published case series by our colleagues Yammine and colleagues in the International Wound Journal sheds light on a deceptively humble yet visually distinctive presentation in the diabetic foot: the “sausage toe.” Once thought rare, this bulbous, swollen toe is increasingly recognized as a clinical marker of underlying osteomyelitis. The study offers a thoughtful reappraisal of... Continue Reading →
A new study published in The International Journal of Lower Extremity Wounds by our long time friends and colleagues in Spain offers a cautionary reminder: not all positive cultures mean bone infection. In a cohort of 93 patients undergoing conservative surgery for diabetic foot osteomyelitis, researchers compared microbiological cultures from bone resection margins with histopathology—the gold standard. Their... Continue Reading →
Screenshot Bone Biopsy vs. Deep Tissue Culture: The Smackdown for Diagnosing Diabetic Foot Osteomyelitis When it comes to diabetic foot osteomyelitis (DFO), there’s one big question: How do we diagnose it accurately? For years, bone biopsy has been considered the heavyweight champion of diagnosis—but it’s invasive, requires surgical skill, and isn’t always feasible. Meanwhile, deep tissue cultures offer a quicker, less... Continue Reading →
Diabetic foot osteomyelitis (DFO) is a formidable challenge in limb preservation, often leading to major amputations and significant morbidity. Systemic antibiotic treatments are fraught with limitations—poor tissue penetration due to peripheral arterial disease, risks of systemic toxicity, and antibiotic resistance. But what if we could deliver antibiotics exactly where they are needed most? A groundbreaking randomized controlled... Continue Reading →
