The study
A comparison of foot and non-foot osteomyelitis in adults treated surgically, published in the Archives of Orthopaedic and Trauma Surgery on 27 September 2026.
It included 202 patients: 89 with foot osteomyelitis and 113 with osteomyelitis at other sites. The authors compared clinical features, the route of infection, microbiology and outcomes between the two groups.
What they found
Diabetes. About half of those with foot osteomyelitis had diabetes (49.4%), compared with one in twenty of those with osteomyelitis elsewhere (5.3%). The paper reports this as an odds ratio of 14.15: the odds of having diabetes were about 14 times higher in the foot group. Its 95% confidence interval, the range the true figure most likely sits in, runs from 4.32 to 46.42. The link is clear, but its exact size is imprecise.
Route of infection. Contiguous spread, where infection reaches bone from adjacent soft tissue such as an ulcer, accounted for 73.0% of foot osteomyelitis.
Microbiology. Polymicrobial infection was more common in the foot group.
Amputation. Amputation occurred in 50.6% of the foot group against 15.9% of the non-foot group (p < 0.001).
No funding was received for the study, and the authors declare no competing interests.
What it means for your practice
Most foot osteomyelitis arrived by contiguous spread. Nearly three-quarters reached bone from adjacent soft tissue, and half the patients were diabetic. That fits the usual picture of foot osteomyelitis developing beneath an ulcer, though the paper reports spread from adjacent tissue rather than ulcer status specifically.
Foot infections were more often polymicrobial. That strengthens the case for bone sampling over a superficial swab when choosing antibiotics.
The amputation rate belongs to a surgical cohort. Every patient here was treated surgically, which selects for more advanced disease. The 50.6% figure should not be quoted as the amputation risk for diabetic foot osteomyelitis generally, and many cases are managed without surgery.
Bottom line
Foot osteomyelitis is strongly associated with diabetes, usually spreads from adjacent soft tissue, and is more often polymicrobial than osteomyelitis elsewhere. In this surgical cohort, amputation was three times as common in the foot. Prevention sits with ulcer care.
For offloading evidence in diabetic foot ulcers, see knee-high offloading beats usual care for diabetic foot ulcers, custom or prefabricated.