Ulcer with extensive deep soft tissue infection

This involves the skin and subcutaneous tissues. This is a severe infection involving the deep soft tissues of the foot. In the presence of neuropathy, pain and throbbing may be absent, but if present this is a danger sign, usually indicating serious infection with pus within the tissues. Palpation may reveal fluctuance, suggesting abscess for mation. There may be bulging of the plantar surface of the foot.

Discrete abscesses are relatively uncommon in the infected diabetic foot. Often there is a generalized sloughing of the ulcer and surrounding subcutaneous tissues which eventually liquefy and disintegrate. A probe can often be inserted deep into the foot. These infections are often polymicrobial and both Gram-positive and Gramnegative organisms are present together with anaerobes.

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