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Osteomyelitis presents with heterogeneous clinical, etiological, and microbiological characteristics depending on anatomical location. While foot osteomyelitis is commonly associated with diabetic foot infections and contiguous spread, non-foot osteomyelitis often arises from post-traumatic, hematogenous, or postoperative causes. However, direct comparative analyses between these two entities remain limited.

A retrospective analysis was conducted on 202 adult patients who underwent surgical treatment for osteomyelitis between 2011 and 2026. Patients were divided into foot (n = 89) and non-foot (n = 113) osteomyelitis groups. Clinical, etiological, microbiological, and treatment-related variables were compared. Only intraoperatively obtained deep tissue and/or bone cultures were included.

Patients with foot osteomyelitis were older and had a significantly higher prevalence of diabetes mellitus (49.4% vs. 5.3%, p < 0.001), which was identified as an independent predictor of foot osteomyelitis (OR 14.15, 95% CI 4.32-46.42; p < 0.001). Infections in foot osteomyelitis predominantly developed via contiguous spread (73.0%), whereas non-foot osteomyelitis showed more heterogeneous etiologies, including post-traumatic and hematogenous causes (p < 0.001). Microbiologically, Staphylococcus aureus was the most common pathogen in non-foot osteomyelitis, while foot osteomyelitis demonstrated a more diverse distribution with higher rates of polymicrobial infections. Amputation was significantly more frequent in the foot group (50.6% vs. 15.9%, p < 0.001), whereas antibiotic-loaded cement use was more common in non-foot osteomyelitis (p < 0.001).

Foot and non-foot osteomyelitis differ significantly in clinical, etiological, and microbiological characteristics. These findings suggest that foot and non-foot osteomyelitis differ in their clinical, etiological, and microbiological characteristics and may require different diagnostic and therapeutic approaches.