Cleanse, debride, probe, and obtain deep anaerobic + aerobic cultures
Assess for PVD: sensation, pulses, ABIs
Diagnosis
Deep tissue wound cx at time of debridement (ideally prior to antibiotics). Superficial swabs are typically of limited utility due to colonization.
For mod/severe: obtain blood cx, ESR, CRP
Osteomyelitis should always be ruled out. At ↑ risk if: grossly visible bone or able to probe to bone, ulcer >2 cm, ulcer duration >1–2 wk, ESR >70. If suspicious for osteo, obtain plain films ± MRI (see osteomyelitis below).
Treatment-diabetic foot infections