We are keeping our office open to make sure our patients with infection, injuries and pain are cared for in our clean, uncrowded office instead of having to go to an Urgent Care or ER where they run the risk of being exposed to COVID-19.

Diabetic Foot Infection With Osteomyelitis (Graphic Content)

This is a patient of mine who have had toes amputated from infected foot ulcers before, so unfortunately he already knew that he has a bad infection in his foot.

The knuckle underneath the third toe is exposed and there is pus deep within his foot, making his third toe very swollen. It is possible to save the third toe, but when the knuckle is infected, trying to save the toe bones will likely require long term IV antibiotics. The small toes are not that important for walking, so we agreed on a third ray amputation (an amputation of the third toe and the knuckle attached to it, also known as the metatarsal). With infection control surgery, I cannot see bacteria, I can only see the “footprints”. They take many forms, typically in the form of pus, liquefied tissue, or blood vessels clots, so all of these will be removed, but sometimes a few bits of bacteria are still hiding somewhere. Closing the wound when there is still bacteria in the body puts the patient at risk for having another infection, so this is why sometimes I stage the surgery, the first one is to remove infection and leave the wound open. The second surgery will be to remove any remaining infection, and if the wound looks clean, I will close it with sutures. In the photo below, I used a wound vac after surgery to get the deeper tissues to heal a little bit faster. After 3 weeks of non-weight-bearing, the sutures were removed, and he was allowed to walk in regular shoes.


3 days after surgery with wound vac


5 days after surgery with wound vac


2 weeks after wound closure


3 months after wound closure
Author
Dr Haywan Chiu, DPM Haywan Chiu

You Might Also Enjoy...

Selecting Appropriate Shoe Gear

Picking a new pair of shoes can feel overwhelming. With a quick glance at social media, you will find ultra rigid shoes, minimalist shoes, or even sandals which all claim to be best for marathon runners. So, what works best? See our recommendations!

Surgical Treatment for Diabetic Foot Ulcers

Diabetic foot ulcers are treated by removing the ground, or removing the bone. It sounds like an amputation but it’s not. Usually, foot ulcers are located on areas of the foot where there is a joint or prominence...

Why Do Diabetic Feet Develop Hammertoes?

When a toe contracts, it usually straightens back out. Over time, either due to arthritis, diabetes, or overuse, it can stay in a clawed or hammered position causing problems. For people without nerve damage (neuropathy), it can be painful...

Charcot foot

Arthritis in a neuropathic foot can get so bad that the bones and joints of the foot breaks down. The medical term is called Charcot neuroarthropathy (pronounced shark-o). It can happen to any joint of the body, but the most common area is the foot's arch.

Why don't we leave wounds open to air?

Scrapes and scratches in kids are commonly left to scab and heal without bandaging, but diabetic foot ulcers don't heal as well with this method. Find out why with this short article.