Great toe osteomyelitis in patients with diabetes often leads to surgical resection, making effective conservative treatment strategies important for preserving foot function and biomechanics. Findings presented at the ADA Scientific Sessions 2026 evaluated outcomes of conservative management in patients with radiographically confirmed great toe osteomyelitis.

This retrospective cohort study included patients with diabetic foot ulcers involving the great toe and radiographic evidence of osteomyelitis. Among 300 identified patients, 250 were included in the final analysis after exclusions for death, loss to follow-up, referral, and major amputation. Baseline demographic characteristics, glycemic measures, vascular status, and ulcer duration were analyzed. Comparative analyses were conducted between healed and non-healed groups.

Findings

• Complete healing with conservative management was achieved in 227 of 250 patients (90.8%), while 23 patients (9.2%) remained unhealed.
• Mean patient age was 62.6 ± 10.2 years, and mean diabetes duration was 16.8 ± 10.0 years.
• Mean baseline glycated hemoglobin (HbA1c) was 10.06 ± 1.99%, indicating poor glycemic control across the cohort.
• Ulcer duration before treatment initiation was significantly longer among non-healed patients (P=0.003).
• Age, glycemic parameters, duration of diabetes, and ankle-brachial index did not demonstrate associations with healing outcomes.

This analysis showed high healing rates with conservative management in patients with diabetic great toe osteomyelitis. Longer ulcer duration before treatment appeared associated with a lower likelihood of healing, supporting the importance of early evaluation and treatment in diabetic foot complications.