Limb Preservation for Multiple Ray Osteomyelitis in Diabetic Forefoot Charcot: A Case Report

This case report describes a very rare presentation of multifocal diabetic foot osteomyelitis (DFO) involving multiple rays and associated with forefoot Charcot neuroarthropathy. Based on magnetic resonance imaging findings and subsequent histopathological examination, the osteomyelitis was confirmed to be confined to the second and third metatarsals, the proximal phalanges of the hallux and second toe, and the metatarsal head and proximal phalangeal base of the fourth ray. Treatment consisted of complete resection of all infected bone in accordance with the principles of internal pedal amputation. The defects created following second-ray metatarsectomy and proximal phalangectomy of the hallux were filled with antibiotic-impregnated bone cement. At the 1-year follow-up, following this limb-sparing procedure, the patient was pain-free, free of infection, and able to bear full weight.