Clinical and functional outcomes of the silo technique in the management of diabetic calcaneal osteomyelitis

TL;DR

A new surgical technique called the Silo method shows good results in treating diabetic foot infections by reducing infection and saving limbs.

Contribution

The Silo technique introduces a novel use of antibiotic-loaded bioceramics in partial calcanectomy for diabetic calcaneal osteomyelitis.

Findings

Infection eradication was achieved in 97% of patients.

Ulcer healing occurred in 90% of patients, with a 26.7% ulcer recurrence rate.

Limb salvage was achieved in 93.3% of patients.

Abstract

Partial calcanectomy is an established alternative to amputation in diabetic calcaneal osteomyelitis, with recent studies utilising adjuvant local antibiotic delivery devices to improve outcomes. The Silo technique is a novel approach involving an antibiotic-loaded hydroxyapatite calcium sulphate bioceramic (Cerament G or V) implanted into pre-drilled holes in the calcaneus.

This retrospective case series involved 30 patients with chronic diabetic calcaneal osteomyelitis that underwent partial calcanectomy with Cerament G or V application via the Silo technique between 2014 and 2024. Patients were further followed up on their ambulatory status via telephone consultation. Primary outcomes were infection eradication, ulcer healing, limb salvage, patient mortality and ambulatory status.

Infection eradication was achieved in 29 (97%) patients, ulcer healing in 27 (90%), and limb salvage in 28 (93.3%). Ulcer recurrence occurred in 8 (26.7%) patients. The all-cause mortality rate was 6.7% at 1-year and 43.3% at 5-years. With regards to ambulatory status, 6 (20.0%) patients improved their ambulatory status from baseline, 20 (66.7%) maintained their baseline ambulatory status, and 4 (13.3%) deteriorated in ambulatory status from baseline.

The Silo technique for diabetic calcaneal osteomyelitis demonstrates promising clinical outcomes, including infection eradication, ulcer healing, ulcer recurrence, limb salvage, 1-year mortality, and mobility. Further prospective studies with larger cohorts and randomised controlled trials are warranted to validate these exploratory findings and to better understand the factors influencing both short and long-term outcomes.

The online version contains supplementary material available at 10.1186/s40842-025-00238-4.

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