Biomechanical changes caused by structural
foot deformities predispose patients to plantar ulceration.
Plantar ulcer recurrence often leads to
osteomyelitis, which is more commonly observed in patients with diabetes. Once the
infection of
diabetic foot ulcer (DFU) spreads and is complicated by
osteomyelitis, treatment becomes more complicated and difficult.
Osteomyelitis treatment remains challenging because of low
drug concentration within the tissue caused by poor circulation and inadequate localized nutrition. Moreover, tissues around
plantar ulcers are fewer and are thin, making the formation of granulation tissues difficult due to elevated plantar pressure. Furthermore, the skin around the
wound is excessively keratinized, and the epidermis is hard to regenerate. Meanwhile,
skin grafting at that site is often not successful due to poor blood circulation. Therefore, it is technically challenging to manage diabetic pressure
plantar ulcer with
osteomyelitis and prevent its recurrence. Here, we present a case of chronic DFU complicated by
osteomyelitis due to
foot deformity. The
ulcer was successfully healed using advanced
wound repair technology comprising of surgical bone resection,
vancomycin-loaded
bone cement implant,
negative-pressure wound therapy, and autologous platelet-rich gel. Subsequently, preventive foot care with custom-made offloading footwear was prescribed. The
plantar ulcer did not recur and improvement in biomechanical parameters was observed after the intervention. This case represents an effective and comprehensive management strategy for
limb salvage and prevention in patients with complicated foot conditions.