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Treating foot infections in diabetic patients with surgical debridement followed by oral antibiotic therapy appears to be as effective and less expensive than other treatments. Foot infections are a common complication of diabetes, and they can lead to osteomyelitis (bone inflammation) that may need to be treated with amputation. Surgical debridement involves cutting away infected tissue and cleaning a wound. Researchers used a computer model to analyze treatment strategies in relation to cost and quality-adjusted life expectancy. Treatment strategies included both short and long courses of antibiotics after debridement, diagnostic tests including imaging, laboratory tests and biopsy, and immediate amputation. Expensive and invasive tests did not appear to give any advantage in improved survival or quality of life. The best option in terms of cost-effectiveness was culturing the debrided tissue to identify the infecting organism and treating with an appropriate antibiotic for 10 weeks., Objective.--To examine the cost-effectiveness of approaches to the diagnosis and treatment of patients with type II (non-insulin-dependent) diabetes mellitus (NIDDM) who have foot infections and suspected osteomyelitis. Design.--Decision and cost-effectiveness analyses were performed using a Markov model. We examined the prevalence of osteomyelitis, the major complications and efficacies of long-term antibiotic therapy and surgery, and the performance characteristics of four diagnostic tests (roentgenography, technetium Tc 99m bone scanning, indium In 111-labeled white blood cell scanning, and magnetic resonance imaging). Data were drawn from the English-language literature using MEDLINE searches and bibliographies from selected articles. Setting.--Primary care. Patients.--Patients with NIDDM who had foot infections and suspected osteomyelitis but no signs of systemic toxicity. Interventions--Following hospitalization for surgical debridement and intravenous antibiotic therapy: (1) treatment for presumed soft-tissue infection, (2) culture-guided empiric treatment for presumed osteomyelitis, (3) 71 combinations of diagnostic tests preceding antibiotic therapy for osteomyelitis, (4) 71 combinations of tests preceding amputation, and (5) immediate amputation. Main Outcome Measures.--Quality-adjusted life expectancy, average costs. Results.--Culture-guided empiric treatment for osteomyelitis with 10 weeks of oral antibiotic therapy has similar effectiveness to testing followed by a long course of antibiotic therapy if any test result is positive. However, empiric treatment is the least expensive strategy. Conclusions.--Noninvasive testing adds significant expense to the treatment of patients with NIDDM in whom pedal osteomyelitis is suspected, and such testing may result in little improvement in health outcomes. In patients without systemic toxicity, a 10-week course of culture-guided oral antibiotic therapy following surgical debridement may be as effective as and less costly than other approaches. (JAMA. 1995;273:712-720)