A 69-year-old Aff o-American man with type 2 diabetes of 22 years' duration and peripheral vascular disease, presented to the diabetic foot clinic with a limb-threatening deep plantar space infection of his left foot. Physical examination revealed an erythematous, swollen foot with fluctuance in the medial arch. There was a full-thickness ulcer noted beneath the 1st metatarsal head, with pus present in the wound. The ulcer probed to bone. He was febrile with an elevated WBC count and elevated serum glucose 400 mg/dL (22.2 mmol/L). The patient was admitted to hospital, and preoperative laboratory testing, chest X-ray, electrocardiogram and medical consultation were obtained. Empiric intravenous antibiotic therapy was initiated and the patient was taken to the operating theatre the same evening for extensive incision and drainage of his foot. The incision extended from the 1st metatarsal head to his ankle (Fig. 8.3).
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