Chronic osteomyelitis should be diagnosed by a combination of clinical manifestations, laboratory tests and imaging examinations. The gold standard for diagnosis is the histological and microbiological examination of dead bone taken by biopsy. The examination should pay attention to the integrity of the skin and soft tissues, determine the localization of pressure points, check the stability of the bone, and determine the neurovascular condition of the limb. Laboratory tests are generally not specific and do not determine the severity of the infection. ESR and CRP are elevated in the vast majority of patients, but leukocytes are elevated in only 35% of patients. A variety of imaging modalities can be used to examine patients with chronic osteomyelitis; however, none of them can definitively confirm or exclude osteomyelitis. The purpose of imaging is to help confirm the diagnosis and preoperative preparation. Useful information to confirm the diagnosis of chronic osteomyelitis can be obtained from x-rays, and this examination should be done at the outset. The presence of cortical bone destruction and periosteal reaction is strongly suggestive of osteomyelitis. Tomograms, which used to be routine in the past, are no longer, but they are useful in detecting dead bone. If sinus tracts are present, sinus angiography should be done, which is useful in developing surgical plans. An isotope bone scan is useful in diagnosing acute osteomyelitis, but is of little use in chronic osteomyelitis, which usually does not show abnormalities on plain films. Areas of increased blood flow within the bone or areas of increased osteogenic activity show increased resorption on technetium 99 bone scan, but are not specific. However, the test has a significant negative exclusion effect, although false negatives have been reported. Gallium scans show increased uptake in areas of leukocyte or bacterial aggregates. If the gallium scan is normal, the absence of osteomyelitis can be confirmed, and follow-up with a gallium scan after surgery is useful. Indium 111 labeled leukocyte scans are more sensitive than technetium scans and gallium scans and are useful in identifying chronic osteomyelitis and diabetic neuropathy of the foot. CT clearly shows cortical bone and gives a good view of the surrounding soft tissues and is particularly useful in examining dead bone. MRI examines soft tissue better than CT and shows edematous areas of bone very well. Chronic osteomyelitis can show well-defined areas of high signal on MRI films surrounded by active lesions (ring sign). Sinus tracts and cellulitis show high-signal areas on T-2 weighted images. disadvantages of MRI include: it is expensive, the area around the metal endophyte cannot be examined, and the cortical bone does not show well. As mentioned earlier, the gold standard for the diagnosis of osteomyelitis is biopsy followed by culture and drug sensitivity testing. Biopsy not only confirms the diagnosis, but also helps to select a sensitive antibiotic. Chronic osteomyelitis is usually difficult to cure without surgery. Surgical treatment of chronic osteomyelitis includes: resection of dead bone, infected and scarred bone and soft tissue. The goal of surgery is to destroy the infection by establishing a viable, well-circulated environment. Thorough debridement may be required to achieve this goal. Incomplete debridement may contribute to the high recurrence rate of chronic osteomyelitis. Thorough debridement often leaves a large dead space that needs to be addressed to prevent recurrence of infection and instability due to large bone loss. Appropriate reconstruction of the bone and soft tissue defect may be required and, the pathogenic organism of the infection should be identified and treated with appropriate antibiotics. Reconstructive surgery should only proceed after careful identification of dead bone and abscesses by radiographs, sinus imaging, CT and MRI, and careful planning. Gallium scans and iodine 111-labeled leukocyte scans are also very useful. During the reconstructive procedure, it is important to work with a physician who is involved in infection control. Reconstructive surgery requires the assistance of a surgeon skilled in tissue coverage procedures, including skin grafts, muscle and muscle flap grafts, and sometimes free flap grafting techniques. There is still controversy about how long to use antibiotics after surgery. The traditional approach is to give antibiotics via IV for 6 weeks after debridement of chronic osteomyelitis. Reports of antibiotics given transvenously for only 1 week postoperatively, followed by 6 weeks of oral antibiotics, have a success rate of 91%.