Limb-Sparing Surgery for Multidrug-Resistant Diabetic Foot Osteomyelitis

A 30-year-old woman with type 2 diabetes was referred from another hospital with extensive diabetic foot osteomyelitis involving the second and fourth metatarsals. Bone cultures revealed a multidrug-resistant organism, resistant to all available intravenous antibiotics. The infection was extensive and later recurred in the fourth metatarsal despite the initial procedure, making limb preservation particularly challenging.

A staged limb-salvage approach was undertaken. Radical debridement and resection of the infected second metatarsal were initially performed until healthy, infection-free bone margins were obtained. Following recurrence, the infected fourth metatarsal was also resected. Throughout treatment, every effort was made to preserve viable plantar soft tissues and maintain the structural integrity of the foot, allowing gradual healing by secondary intention while eradicating the infection.