Successful treatment of osteomyelitis and soft tissue infections in ischemic diabetic legs by local antibiotic injections and the end-diastolic pneumatic compression boot.

Thirty-four legs at risk of amputation due to peripheral arterial insufficiency associated with ischemic necrosis, soft tissue infections, osteomyelitis, and variable degrees of peripheral neuropathy were reported in 28 diabetic patients. Amputation had been considered in 27 legs for which standard therapies had failed for the current illness and in two legs in which standard therapy had failed for previous illnesses. Local therapy was the initial form of therapy for five legs in which standard therapy appeared likely to fail. Infection was controlled in all patients with the use of local antibiotics and compression boot therapy. Early leg amputation was avoided in all but one patient. Late leg amputation occurred in two patients who were lost to follow-up care. Osteomyelitis, ischemic necrosis, and advanced soft tissue infection were shown not to be clear-cut indications for amputation in the ischemic diabetic foot.