Assessment for infection

Always assess high-risk foot wounds for infection; see Ulcer and wound infection. Signs of infection are often subtle in patients who have diabetes or are significantly immunocompromised, and these patients can deteriorate rapidly. Collect wound swabs to identify the pathogen and guide antibiotic therapy. Thorough assessment and close monitoring is important. See also Diabetic foot infection.

If an infection is identified, investigate for osteomyelitis. A simple and accurate technique is to probe for bone (see Foot examination). Assess for osteomyelitis and infection at the initial presentation of a foot wound, and at regular intervals in a chronic foot wound. Consider an X-ray to assist with the identification of osteomyelitis; however, it can take up to 4 weeks for bony changes due to osteomyelitis to be visible on X-ray. For more information on diagnosis and management of osteomyelitis, see Osteomyelitis.