Background:
Neuropathic foot ulceration can lead to a portal of entry for pathogens to infect the underlying soft tissues and ultimately bone. This paper reports the characteristics of presenting Diabetic Foot Osteomyelitis cases of Bedouin patients in Saudi Arabia.

Methods:
A retrospective study of patient’s charts was conducted at a regional diabetic foot clinic. Osteomyelitis was confirmed via bone biopsies following deep wound swab cultures.

Results:
66 cases of confirmed Osteomyelitis were noted in 102 joints. Mean HbA1c of patients was 9.9% (SD±2), ESR was 87.6 mmol/L (SD±38.6), CRP was 96 mg/l (SD±88.4). Osteomyelitis was most common in MTPJ’s in 39.2% of presentations (40 joints). Interdigital ulceration to the 4th or 5th toes was second most common preceeding event to osteomyelitis in 13 (19.7%) patients. 64 patients (97%) patients had preceeding foot ulcer to osteomyelitis event. 50 of the cases (78.1%) a positive probe to bone test was recorded. Gram positive bacteria were the predominating organisms (69.6%), S. aureus accounting for 35.9%. Gram negative bacteria cultured in 26.8% of bone biopsies, Klebsiella pnuemoniae the most predominant gram negative bacteria isolated from osseous cultures in 26.7%. Of the 66 osteomyelitis cases, 44 surgical procedures were undertaken, with resection of bone being the most common procedure in 48% of patients, followed by Incision and drainage in 27.5%.

Conclusions:
Weight bearing areas are prone to neuropathic ulceration and this can lead to DFO. Offloading should form part of the standard assessment in these patients. Patients with religious beliefs that require cleansing of their feet before prayer may need education on foot care and the importance of drying in-between their toes in order to reduce or prevent Interdigital ulceration that may ultimately lead to DFO. Laboratory findings of elevated ESR seem to correlate with previous findings and maybe useful in conjunction with clinic signs.