Osteomyelitis in pressure ulcers

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Osteomyelitis in pressure ulcers

Jacqui Fletcher, Leanne Atkin, Graham Bowen, Chloe Cox, Jackie Dark, Michael Edmonds, Eva Harris, Francesca Knapper, Clare Rogers, Stephanie Stanley, Heidi Sandoz

4 November 2025

A multidisciplinary group of experts met online in April 2025 to discuss management of osteomyelitis. It quickly became apparent that osteomyelitis in pressure ulcers (PUs) is a particularly challenging area, in which evidence and guidance are needed. There is currently a lack of both evidence and clinician knowledge and confidence in how to treat patients with osteomyelitis in PUs, in particular PUs that occur on the sacrum or other larger bony areas.

Within podiatry, there is a clear pathway for treating patients with osteomyelitis in PUs that occur on the foot (below the ankle). However, in PUs that occur above the ankle, current practice is less clear. Data clearly identify that the sacral area is the place where deep pressure ulcers are most commonly seen in practice; however, this is where there is the greatest lack of evidence.

This best practice document aims to fill this gap and provide much-needed guidance to all clinicians, with the ultimate aim of providing standardised optimal care to patients. Drawing on existing evidence and the experts’ experience, this document will provide guidance on how to:

Identify osteomyelitis in PUs above the ankle
Diagnose osteomyelitis using testing methods available in local practice
Assess and classify pressure damage and osteomyelitis, with a holistic assessment checklist
Use a standardised pathway to provide effective treatment
Change team mindsets to encourage optimal practice
Improve patient experiences and outcomes.

The document also aims to highlight the importance of interdisciplinary and multidisciplinary team (MDT) working. Experience has shown that this is the key way to improve outcomes in this complex group of patients.

We hope this document will empower clinicians, raising awareness of this important area and providing the knowledge and confidence they need to deliver gold-standard care to patients.

Jacqui Fletcher, Chair

Download the PDF below to access the full Best Practice Statement

↓ Download pdf

Disclaimer: This document has been developed by Wounds UK and is supported by an unrestricted educational grant from Biocomposites

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