2739-LB: Conservative Management of Great Toe Osteomyelitis Achieves High Healing Rates in Diabetic Foot Ulcers: A Retrospective Cohort Study

Introduction and Objective: Great toe osteomyelitis frequently leads to surgical resection. Preservation of the hallux is critical for maintaining normal gait and foot biomechanics. With conservative treatment strategies including antibiotics, wound care, and off-loading, reported remission rates for non-surgical diabetic foot osteomyelitis are typically 60-80%, with recurrence or re-amputation rates ranging from 20-50% after ray amputation. We evaluated outcomes of conservative management in patients with radiographically confirmed great toe osteomyelitis. Methods: This retrospective cohort study included patients presenting with diabetic foot ulcer involving the great toe with radiographic evidence of osteomyelitis. Out of 300 patients identified, 250 were included in the final analysis after excluding deaths (n = 6), loss to follow-up (n = 27), referral (n =15), and major amputation (n = 2). Baseline clinical characteristics, glycemic parameters, vascular status, and ulcer duration were analyzed. Comparative analyses were performed between healed and non-healed groups. Results: Of the 250 patients, 227 (90.8%) achieved complete healing with conservative treatment, while 23 (9.2%) remained unhealed. The mean age was 62.6 ± 10.2 years and the mean duration of diabetes was 16.8 ± 10.0 years. Despite poor glycemic control (mean HbA1c 10.06 ± 1.99%), most ulcers healed successfully. The duration of ulcer prior to treatment was significantly longer in non-healed patients (p = 0.003). Age, glycemic parameters, duration of diabetes, and ankle-brachial index were not associated with healing. Conclusion: Conservative management of radiographically confirmed great toe osteomyelitis resulted in high healing rates. Early presentation and multidisciplinary care appear to be key factors contributing to favorable outcomes. These findings support hallux-preserving conservative strategies as a potential limb-salvage approach in selected patients with diabetic foot osteomyelitis. Disclosure A. Vijayakumar: None. S. G k: None. V. Gadadharan: None. G. Satheesh: None. A. Jaleel: None.