Search Results (109)

Introduction: Diabetic foot ulcers (DFUs) are a debilitating complication of diabetes, and management by multidisciplinary foot teams have been shown to reduce serious sequelae, such as amputations. There are stark racial and ethnic disparities in morbidity and mortality from DFUs, and multidisciplinary care has been shown to reduce lower extremity amputations, length of hospital stays and readmissions. This is a review of the impact of multidisciplinary care on DFUs, particularly regarding social determinants of health, with an illustrative case. Case Presentation: This is a case of a 32-year-old African American male with Type 1 Diabetes, a history of poor glycemic control, attention deficit hyperactivity disorder, tobacco and marijuana use disorder, and multiple social and structural barriers to care. He presented with bilateral Wagner grade 3 DFUs with osteomyelitis to the emergency department, requiring hospitalization. Upon discharge, he was referred to a multidisciplinary diabetes clinic and received coordinated support from endocrinology, podiatry, vascular surgery, infectious disease, pedorthics, and behavioral health. Comprehensive evaluation, intensive wound care with adjuvant hyperbaric oxygen therapy, offloading, blood glucose management and medical source control of infection were established for his treatment plan. At the three-month follow-up, the patient’s wound beds had significantly improved, and his Hemoglobin A1c declined from 12.6% to 9.3%. The right plantar wound completely epithelialized, and the left foot wound showed 90% contracture. Review and Discussion: This case highlights the importance of integrated, multidisciplinary care for DFUs, particularly in addressing both the clinical and social drivers of complications from diabetes. Full article

Background: Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic administration on treatment failure among patients with diabetic foot osteomyelitis. Methods: The authors conducted a retrospective cohort study among patients with unresected diabetic foot osteomyelitis. A propensity score was used to match the treatment exposure groups. The primary outcome was treatment failure, defined as either (1) treatment with additional antibiotic course or (2) additional surgical debridement/amputation at the original site of infection within 1 year of initial treatment. Secondary outcomes included the impacts of hemoglobin A1c, peripheral arterial disease, obesity, and infection severity on treatment failure. Results: Among 152 patients meeting criteria, 49 matched pairs were analyzed. Treatment failure rates did not significantly differ between oral and intravenous groups (OR 0.98, 95% CI 0.30–3.19, p > 0.9). A time-to-event analysis similarly found no significant outcome disparities between groups (p = 0.3). Conclusions: The study results support the previously published literature that demonstrates comparable treatment outcomes between routes of antibiotic administration when treating diabetic foot osteomyelitis. Full article

Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but less is known about whether simple high-risk foot documentation flags identify presentation records with higher care-pathway intensity. The primary objective was to estimate the presentation-level burden of core high-risk foot profiles among pilgrims presenting with foot and ankle conditions during Hajj 2025. Secondary objectives were to evaluate associations with a surgery-coded care-intensity indicator, hospital referral, and component heterogeneity. Methods: This observational presentation-level analysis included 3957 foot and ankle presentation records. The unit of analysis was the presentation/case record, not a unique individual pilgrim. A core high-risk foot profile was defined as diabetes, neuropathy, diabetic foot ulcer, foot ulcer, complications of open wound, or osteomyelitis. The primary outcome was a surgery-coded care-intensity indicator, defined solely from treatment documentation containing “Surgery” and interpreted as a care-pathway proxy rather than confirmed operating-room surgery. Logistic regression estimated crude and adjusted odds ratios (ORs); exploratory risk-category analyses assessed heterogeneity within the composite profile. Results: Core high-risk foot profiles were identified in 1793/3957 presentations (45.3%). The primary outcome occurred in 239/1793 high-risk presentations (13.3%) and 201/2164 non-high-risk presentations (9.3%), an absolute difference of 4.0 percentage points. The crude OR was 1.50 (95% CI 1.23–1.83; p < 0.001). The association persisted in the primary adjusted model (adjusted OR 1.47; 95% CI 1.20–1.79; p < 0.001) and in the extended clinical sensitivity model (adjusted OR 1.47; 95% CI 1.20–1.80; p < 0.001). Care pathways and secondary outcomes are summarized was also more frequent in high-risk presentations (12.2% vs. 9.8%; crude OR 1.28; 95% CI 1.05–1.57; p = 0.017). Exploratory category analysis showed that chronic-risk-only presentations had a primary outcome rate similar to non-high-risk presentations (9.0% vs. 9.3%), whereas ulcer/wound/deep-infection presentations had a higher rate (17.3%; crude OR 2.04; 95% CI 1.63–2.55; p < 0.001). Model discrimination was modest (C-statistics 0.55–0.64). Conclusions: Core high-risk foot flags were common among Hajj foot and ankle presentation records and were associated with surgery-coded care-intensity and referral documentation. However, the composite was clinically heterogeneous, the outcome was not a validated surgery endpoint, and the models were not prediction tools. These findings support cautious use of high-risk foot flags as operational prompts for assessment and pathway planning rather than as standalone clinical risk estimates. Full article

Background: Diabetic foot infection (DFI) is a serious complication of diabetes mellitus associated with chronic inflammation, impaired wound healing, endothelial dysfunction, and oxidative stress. Sirtuin (SIRT) signaling and the apelinergic system have been implicated in these processes. This study aimed to evaluate serum SIRT1, SIRT3, apelin, and elabela (ELA) levels in patients with DFI and to examine their cross-sectional associations with clinical indicators, inflammatory markers, osteomyelitis, and glycemic control. Methods: This cross-sectional study included 47 patients with DFI and 42 healthy controls. Serum biomarker levels were measured using enzyme-linked immunosorbent assay (ELISA). Clinical and laboratory data, including the infection component of the PEDIS classification, were recorded. Group comparisons, Spearman correlation analyses, receiver operating characteristic (ROC) curve analysis, and logistic regression were performed. Results: Patients with DFI exhibited higher inflammatory and glycemic markers and lower hemoglobin and lipid levels compared with controls (p < 0.05). Serum SIRT1, SIRT3, apelin, and ELA levels were significantly lower in the DFI group and showed inverse correlations with HbA1c, PEDIS stage, disease duration, osteomyelitis, and inflammatory markers. Among these biomarkers, SIRT1 showed the highest discriminative ability within this cohort (AUC = 0.820). In an exploratory multivariable model, age and SIRT1 were independently associated with the presence of DFI. Conclusions: Serum SIRT1, SIRT3, apelin, and ELA levels were lower in patients with DFI and were associated with clinical and biochemical indicators of disease burden. Among these biomarkers, SIRT1 demonstrated the strongest discriminative ability within this cohort. These findings suggest that sirtuin signaling and the apelinergic system may be relevant in the biological context of DFI; however, they should be interpreted cautiously. The observed differences may reflect not only DFI but also underlying diabetes, glycemic burden, age, and systemic inflammation. Further prospective studies including appropriate diabetic comparator groups are required to clarify the clinical relevance and potential utility of these biomarkers. Full article

Introduction: Type 2 diabetes mellitus predisposes patients to neuropathy, peripheral arterial disease, and diabetic foot ulcers, which may become infected and progress to osteomyelitis, increasing the risk of amputation. The growing prevalence of multidrug-resistant organisms complicates management. Photodynamic therapy (PDT), which combines a photosensitizer with light-emitting diode irradiation to generate reactive oxygen species, has emerged as a potential adjunctive antimicrobial strategy without inducing resistance. Objective: To describe clinical outcomes observed in patients with diabetic foot osteomyelitis treated with adjunctive photodynamic therapy (PDT), with emphasis on wound evolution, limb preservation, and healing time. Methods: This prospective case series included patients with osteomyelitis secondary to infected diabetic foot ulcers treated at a university hospital. Demographic and clinical data were collected from medical records. Serial photographic documentation was used to monitor wound progression and tissue response during therapy. Results: Sixteen patients with diabetic foot osteomyelitis were included. Complete healing was achieved in 13 patients (81.25%), while 2 patients (12.5%) remained under treatment with partial healing and 1 (6.25%) underwent major amputation. Among healed patients, healing time ranged from 19 to 546 days, with a median of 118 days. The number of photodynamic therapy sessions ranged from 2 to 12, depending on the clinical course of each case. Healing time varied among patients, and the hallux was the most frequent site of osteomyelitis. During follow-up, only one patient underwent major amputation, whereas the remaining patients either achieved complete healing or were still under treatment at the time of analysis. Healing time was comparable between insulin-dependent and non-insulin-dependent diabetes, although numerically shorter in the latter. Longer healing periods were associated with more treatment sessions. Conclusions: In this prospective uncontrolled case series, adjunctive PDT was associated with favorable clinical evolution in a subset of patients with diabetic foot osteomyelitis. However, because of the small sample size and the absence of a control group, these findings should be considered preliminary and hypothesis-generating. Full article

Background and Objectives: Diabetes mellitus (DM) is a major global health concern, with diabetes-related foot disease (DFD) representing one of its most severe complications, often resulting in chronic infection, osteomyelitis, and limb amputation. Conventional therapies frequently fail in refractory cases, necessitating novel adjunctive strategies. Ozone therapy (OT) possesses antimicrobial, immunomodulatory, and oxygen-enhancing properties, while negative pressure wound therapy (NPWT) facilitates granulation, exudate removal, and tissue perfusion. This study explored the combined efficacy of OT and NPWT in advanced DFD. Materials and Methods: An exploratory, retrospective, observational cohort study was conducted at a specialized wound care center in Gdańsk, Poland, between 2019 and 2022. The study included 30 patients (n = 30) with refractory DFD involving both soft tissue and bone infection who had not responded to previous conventional treatment. The analyzed treatment approach consisted of surgical debridement, application of topical ozonated preparations, and (NPWT) with instillation of ozonated saline administered over a six-week period. Clinical outcomes included wound healing assessed using the Wagner classification and wound volume reduction, pain intensity measured using the Numeric Rating Scale (NRS), inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]), and microbiological characteristics of wound cultures. Statistical analyses were performed using the Wilcoxon signed-rank test and the chi-square test, and regression modeling was applied to identify potential predictors of therapeutic response. Statistical significance was defined as p < 0.05. Results: By week six, 100% of ulcers improved to Wagner stage ≤1, with 26.7% achieving stage 0. Median wound volume decreased from 5.5 cm³ to 0 cm³ (p < 0.001). Pain scores declined from 7.2 ± 0.96 points to 0.2 ± 0.5 points (p < 0.001). CRP and PCT levels decreased significantly (p < 0.001), and microbiological clearance was observed in all cases. Higher body mass index (BMI) was associated with poorer pain reduction. Conclusions: The combination of standard wound care with OT and NPWT was associated with clinically relevant improvements in wound healing, infection control, systemic inflammation, and pain reduction in patients with refractory DFD. Although limited by a non-controlled design and small cohort size, these findings support further randomized controlled trials to define the role of this combined approach in integrated diabetic foot care. Full article

Background: Adipose tissue grafting is a regenerative medicine approach based on the use of autologous adipose tissue showing significant potential for the treatment of diabetic foot lesions. In subjects with diabetes, impaired wound healing, peripheral neuropathy, and vascular insufficiency contribute to the development of chronic ulcers and osteomyelitis, complicating traditional treatment strategies. Materials and Methods: We conducted a retrospective analysis of our center’s database, including all subjects treated for chronic diabetic foot ulcers who underwent adipose grafting with a follow-up of at least six months. For the control group, we included patients who received artificial dermis grafts rather than adipose grafts. Results: We identified 45 patients in the adipose group and 39 in the control group. Baseline characteristics were similar between the two groups for: mean age, diabetes duration, creatinine level, HbA1c, peripheral neuropathy, peripheral vascular disease and osteomyelitis. Coronary artery disease was prevalent in the control group. Wound location demonstrates a prevalent heel involvement for the adipose group. No patients experienced severe complications due to adipose graft: four patients (9%) developed a hematoma at the adipose tissue harvesting site, which was resolved spontaneously. At a mean follow-up of 12 ± 5 months, 30 (67%) patients achieved healing with a mean healing time of 202 ± 82 days, without requiring further surgical interventions. The control group achieved 51% of healing (p = 0.04), with a mean healing time longer than in the adipose graft group: 275 ± 132 days (p = 0.02). Moreover adipose graft permitted the best performance in rearfoot lesions. Conclusions: Adipose grafting is a safe and minimally invasive procedure with no major adverse events. Our data demonstrate its efficacy in promoting healing, even in chronic lesions with osteomyelitis and those located on the heel. Efficacy was found to be superior to that of the artificial dermis graft group. Full article

Background: Diabetic foot osteomyelitis (DFO) is a severe complication requiring effective empiric antibiotic therapy to prevent amputation. While global guidelines suggest tailoring therapy based on climate zones, limited data exist regarding seasonal variations within a single region experiencing distinct seasonal extremes. This study investigated whether the bacterial etiology of DFO differs significantly between the hot, humid summer and the cold, dry winter in the Republic of Korea. Methods: We conducted a retrospective cohort study of 85 patients with DFO who underwent lower extremity amputation between January 2018 and October 2024. Patients were categorized into Summer (July–August) and Winter (December–January) groups. Deep tissue or bone specimens were analyzed to compare pathogen prevalence. Results: A total of 85 patients were included (Summer: n = 45; Winter: n = 40). While Staphylococcus species were the most common pathogens overall (30.6%), a seasonal shift was observed. The proportion of Gram-negative isolates was higher in Summer (50.7%) compared to Winter (35.1%), representing a notable clinical trend (p = 0.080). Specifically, Pseudomonas aeruginosa and Escherichia coli were more frequently isolated during the summer months. Furthermore, polymicrobial infections were more prevalent in Summer (62.2%) compared to Winter (45.0%), although this did not reach statistical significance (p = 0.111). Conclusions: The microbiological profile of DFO exhibits seasonal variations. The observed trend toward an increased prevalence of Gram-negative and polymicrobial infections during the Korean summer suggests that empiric antibiotic guidelines should be dynamic rather than static. Full article

Background: Diabetic foot ulceration represents one of the most severe diabetic complications, with 50–60% progressing to diabetic foot infection (DFI). All diabetic wounds and diseases originate from peripheral vasculopathy and neuropathy, which are caused by oxidative stress and inflammatory processes. We investigated the utility of neutrophil-to-lymphocyte ratio (NLR) and CRP-to-albumin ratio (CAR) as cost-effective inflammatory biomarkers in DFI. Methods: The study included 58 DFI patients and 45 healthy controls. Disease severity was assessed using PEDIS staging. Routine laboratory parameters, NLR, derived NLR (d-NLR), and CAR were measured and compared. Results: In DFI patients, statistically significant increases (p < 0.001) were observed in NLR (3.12 vs. 1.99, p < 0.001), d-NLR (2.13 vs. 1.49, p = 0.003), CAR (0.91 vs. 0.03, p < 0.001), CRP (30.5 vs. 1.3 mg/L, p < 0.001) and PCT (0.1 vs. 0.02 μg/L, p < 0.001) values compared to the control group. Strong correlations existed between NLR, CAR and disease severity markers (CRP, PCT, HbA1c, osteomyelitis, PEDIS stage). ROC analysis revealed excellent discriminatory power for CAR (AUC = 0.915), PCT (AUC = 0.952), and CRP (AUC = 0.902), while NLR showed moderate performance (AUC = 0.702). Conclusions: NLR/CAR demonstrate excellent discrimination vs. healthy controls (AUC 0.915/0.702). The proposed workflow (NLR screening → CAR severity → PCT confirmation) requires prospective validation against with guidelines. Full article

Background/Objectives: Diabetic Foot Ulceration (DFU) is one of the most debilitating and costly complications of diabetes mellitus, representing a significant cause of morbidity, disability, and healthcare burden worldwide. Refractory non-healing ulcers that fail to respond to conventional therapies require novel adjuvant treatment modalities. This clinical audit aimed to evaluate the long-term clinical outcomes of an autologous, bioactive platelet-rich fibrin (PRF) matrix combined with topical gentamicin in patients with chronic, non-healing DFUs. Methods: A retrospective observational audit was conducted, involving eleven patients with refractory DFUs who underwent adjunctive treatment with a PRF matrix (Arthrozheal^®) and co-applied gentamicin. Patients were followed at three-week intervals using standardised wound imaging (Silhouette^® 3D) to assess healing parameters. Long-term follow-up data, evaluating healing durability and complications, is presented. Results: All patients completed the treatment protocol, with significant reductions in mean wound area (87.9%), perimeter, depth, and volume (all p < 0.05). Epithelialised tissue increased from 24.7% to 82.8%. At 12 months, 81.8% of patients maintained complete ulcer healing. Two patients experienced complications: one ulcer recurrence requiring surgical debridement and one unrelated amputation due to osteomyelitis. Conclusions: The combination of autologous PRF matrix and gentamicin demonstrated promising results in promoting sustained healing of refractory DFUs with minimal complications. These findings support further investigation in larger, controlled studies to validate this biologic-antimicrobial approach as a safe, effective, and durable therapy for complex diabetic wounds. Full article

Background/Objectives: diabetic foot osteomyelitis (DFO) is a serious complication characterized by bone infection that can involve cortical structures, bone marrow, and surrounding soft tissues. Its prevalence ranges from 20% in moderate diabetic foot infections to over 50% in severe cases, making accurate diagnosis essential in guiding timely and effective management. in this study, we aimed to evaluate the diagnostic accuracy achieved by combining the probe-to-bone (PTB) test, plain radiography, and blood biomarkers—including the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)—in the diagnosis of DFO. Methods: we conducted a diagnostic accuracy study involving 128 patients with diabetic foot ulcers and clinical suspicion of DFO. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for individual tests and for their diagnostic combinations. Results: the combination of PTB and biomarkers yielded a sensitivity of 75%, a specificity of 24%, a positive predictive value of 69%, and a negative predictive value of 29%. Similarly, the combination of PTB and plain radiography showed a sensitivity of 76%, a specificity of 23%, a positive predictive value of 62%, and a negative predictive value of 38%. When the three diagnostic modalities were analyzed together, the sensitivity reached 75%, and the specificity reached 23%. Conclusions: the combination of PTB and inflammatory biomarkers demonstrated moderate effectiveness and diagnostic performance comparable to PTB combined with radiography. These findings suggest that biomarkers may serve as a practical and accessible diagnostic adjunct in settings where imaging availability is limited or radiographic interpretation is challenging. Full article

Objective: We sought to assess the diagnostic performance of quantitative bone SPECT/CT standardized uptake values (SUVs) in diabetic foot osteomyelitis (DFO) and their associations with inflammatory biomarkers. Methods: We retrospectively reviewed 150 consecutive patients who underwent three-phase bone scintigraphy and foot SPECT/CT (November 2016–December 2024) for DFO before antibiotic treatment; 117 with complete imaging and laboratory data were analyzed. Lesion and contralateral SUVs (SUVmax, SUVmean) were compared. Receiver operating characteristic (ROC) curves were used to determine discrimination and optimal cut-offs (Youden index). Associations with biomarkers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CRP/albumin (ESR × CRP) and hematologic/coagulation indices including mean corpuscular hemoglobin (MCH) and activated partial thromboplastin time (aPTT) were evaluated using Spearman correlations. Results: Lesion uptake and contralateral uptake were SUVmax 10.94 ± 7.36 vs. 3.62 ± 1.70; SUVmean 4.38 ± 3.63 vs. 0.93 ± 0.50. Discrimination was excellent; SUVmax was AUC 0.921 (cut-off 4.47; sensitivity 0.93; specificity 0.75) and SUVmean was AUC 0.961 (cut-off 1.49; sensitivity 0.91; specificity 0.89). CRP and ESR showed weak but consistent positive correlations with SUVs (ρ ≈ 0.25–0.30). The ESR × CRP value correlated most strongly (e.g., with SUVmean ρ = 0.35), and CRP/albumin showed a modest positive association. MCH (ρ ≈ −0.20) and aPTT (ρ ≈ −0.37) were inversely related. Conclusions: Quantitative SPECT/CT provides excellent lesion–contralateral discrimination in DFO. SUVs—particularly SUVmean—track inflammatory burden, supporting their use as practical quantitative adjuncts to clinical and laboratory assessment. Study-specific cut-offs are promising but require local validation. Full article

Background: Osteomyelitis (OM) is a complex bone disease most often caused by microorganism-based infections; it poses significant challenges for diagnosis and treatment. Previous epidemiologic studies have identified upward temporal trends in the diagnosis of OM. This study examined these trends in diabetic OM and OM-related amputations in Texas, a state with one of the highest rates of diabetes in the United States. Methods: Retrospective analysis was conducted on Texas diabetic inpatient hospital data from 2006 to 2016. Data were extracted for patients who had diagnostic codes for diabetes and for foot and ankle OM, along with data for OM-related major or minor amputations. Rates were calculated per 1,000 people and standardized using 2019 population estimates. Results: The prevalence of diabetic OM increased from 2006 to 2016, as did total, major, and minor amputations in patients with OM. Decreases were noted in 2014 to 2016. Age-standardized rates demonstrated the same trends, as did rates across all of the age groups. Osteomyelitis increased most in 45- to 64-year-olds. Amputation rates increased similarly in 45- to 64-year-olds, 65- to 74-year-olds, and those 75 years and older. Poisson regression analysis reinforced these trends, with significant increases in risk ratios forOM and amputation rates in all of the age groups. Conclusions: This preliminary analysis highlights the increasing prevalence of OM and OM-related amputations in diabetic patients from 2006 to 2016 and for all age groups (18– 75 years and older) in Texas. Although increasing diabetes rates may contribute to the observed trends in OM, it does not exclusively explain them. Further research should investigate possible interventions to mitigate the rise in diabetic OM and associated amputations. (J Am Podiatr Med Assoc 115(6), 2025; doi:10.7547/23-192) Full article

Diabetic foot ulcers drive non-traumatic lower-limb amputation; limb salvage surgery is often pursued to preserve function and survival. Predictors of adverse outcomes remain incompletely defined, and evidence for multidisciplinary team (MDT) care is heterogeneous. We aimed to clarify risk factors for major amputation and death after diabetic limb salvage and evaluate MDT impact. We systematically reviewed 49 studies (2020–2025) reporting major amputation or mortality after limb salvage in diabetes (PROSPERO CRD420251044859). Risk factors spanned demographic, clinical, and surgical domains (e.g., older age, male sex, renal/cardiovascular disease, ischemia, osteomyelitis, advanced ulcer classification). MDT models generally showed lower amputation rates and improved wound healing, with occasional survival benefits; heterogeneity precluded meta-analysis. As a real-world comparator, the Mid Essex Diabetes Amputation Reduction Plan (MEDARP) treated 72 high-risk patients using a “toe and flow” MDT. Major amputation occurred in 6.9% and mortality in 12.5%, both at or below published ranges, with gains in patient-reported outcomes. Findings support MDT-based strategies, but conclusions should be interpreted cautiously given the predominantly observational evidence, and highlight the need for standardized outcome definitions and reporting. Full article

Diabetic foot infections (DFIs) are a significant complication in patients with diabetes, often leading to severe clinical complications including amputation and increased mortality rates. The effective management of these infections is complicated by the rise in antibiotic resistance among the microbial populations involved. In this paper, we undertake a systematic review and meta-analysis to explore the bacterial profiles, as well as their antibiotic resistance patterns in DFIs, encompassing studies published between 2014 and 2024. A total of 28 studies were selected from several databases, including PubMed, Google Scholar, EBSCOhost, and ScienceDirect, published from 2014 to 2024, specifically focusing on diabetic foot infections and antibiotic resistance. Diabetic foot infections arise from a combination of factors, including peripheral neuropathy, poor circulation, and immune system impairment, making diabetic patients prone to unnoticed injuries, impaired wound healing, and a higher risk of infections. The severity of DFIs often depends on the size and depth of the ulcers, with larger, deeper ulcers posing additional risks of infection and complications, such as osteomyelitis and sepsis. Our study synthesizes information on the total isolates of microbes, their resistance to one or more groups of antibiotics, and resistance panel results across multiple antibiotics, including amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, ciprofloxacin, and others. We meticulously catalog the resistance of key bacterial strains—Escherichia coli, Enterobacter spp., Proteus spp., Pseudomonas spp., Staphylococcus aureus, and others—highlighting patterns of resistance to single and multiple antibiotic groups. This systematic review also analyzes the correlations of various comorbidities reported by the diabetic foot infection patient populations in the included studies with multiple antibiotic resistance patterns. Subsequently, this analytical review study addresses the rising prevalence of antibiotic-resistant pathogens and underscores the need for antibiotic stewardship programs to promote judicious use of antibiotics, reduce the spread of resistant strains, and enhance therapeutic outcomes. In addition, the review discusses the implications of resistance to empirical antibiotic treatments, underscoring the necessity for tailored antibiotic therapy based on culture and sensitivity results to optimize treatment outcomes. Full article