Chronic Diabetic Foot Osteomyelitis Presented as a Sausage Toe Treated With Internal Pedal Amputation: A Small Case Series.

The treatment of a chronic diabetic foot osteomyelitis (DFO) is challenging and often necessitates a surgical intervention. When the soft tissues are preserved from infection, an internal pedal amputation (IPA) defined as the excision of the totality of at least one bone could yield excellent results in terms of infection control and limb preservation. The diabetic sausage toe is an under-researched form of DFO. Therefore, the aim of this preliminary study is to report the outcomes of IPA for the treatment of chronic diabetic sausage toes. This is a case-series of six patients presenting as chronic diabetic DFO of the toes in the form of sausage toe. Five patients presented with an open ulcer and one with a healed wound. All patients were treated with IPA. Infection healing, x-rays and MRI findings, microbiology and pathology results, postoperative complications and patient satisfaction were recorded. Four out of the six cases (66.7%) presented clear radiological signs of chronic OM. All cases showed signs of OM on MRI. A bacterial micro-organism was found in 5 out of the 6 cases (83.3%) and all specimens showed signs of chronic inflammation on pathology. No infection recurrence was noted at the last follow-up. All postoperative wounds healed within 6 weeks. All patients were extremely satisfied with the surgical result. For chronic diabetic toe osteomyelitis in the form of a sausage toe, the toe-preserving technique of internal pedal amputation has the potential to control the infection while conserving an aesthetic and functional toe. LEVEL OF EVIDENCE: IV.