Infection of soft tissue or bone below the malleoli in a person with diabetes, usually complicating neuropathic ulceration.
Examination
- • Ulcer depth, probe-to-bone test
- • Pulses and ABPI
- • Crepitus, erythema spread, systemic signs
Investigations
- • Deep tissue culture (not superficial swab)
- • X-ray then MRI for osteomyelitis
- • CRP, FBC, HbA1c, ABPI/toe pressures
Management
- • Mild: oral flucloxacillin/co-amoxiclav 1–2 weeks
- • Moderate-severe: IV broad-spectrum, surgical debridement
- • Offloading (total contact cast), revascularisation if ischaemic
- • Osteomyelitis: 6 weeks antibiotics or resection
Clinical pearls
- • Positive probe-to-bone strongly suggests osteomyelitis
- • Absent systemic signs do not exclude severe infection in diabetes
Educational — verify locally.
