Major risk factors that correlated with poor outcomes included peripheral arterial disease, homelessness, Pseudomonas aeruginosa or Escherichia coli bone isolates, a serum albumin level <2.8 mg/dL, hallux involvement, insulin therapy, smoking history of ≥60 pack-years, and <7 days of antibiotic therapy for a positive bone margin. Here, INS is linked to peripheral arterial disease.