The wound will be inspected and classified according to the presence or not of the signs of infection. The ulcer will be graded according to severity. It is not always necessary to take microbiology swabs, bacteria will be colonising the wound but they may not be causing any damage. We have to beware of antibiotic over usage and the resulting tendency to encourage resistant bacterial strains by this practice. However standard antibiotics may be appropriate and these will therefore be prescribed immediately.

Healing will be encouraged by surgical debridement of dead and infected tissues. Thereafter an optimum moist environment is established and suitable dressings are applied. The diabetes should be adequately controlled and any other metabolic abnormalities diagnosed promptly and treated appropriately. With the help of the podiatrists and wound care nurses mild and moderate infections should respond fairly quickly and the wound should then show signs of healing.

Infections which are resistant to standard antibiotics is fast becoming a major problem in wound management. MRSA is well known in the popular press but there are others which are now emerging as serious contenders for bacterial super bug of the year. We have to be very diligent in preventing these by limiting antibiotic usage but at the same time we are needing more and more powerful antibiotics in the battle to save limbs. It is a very difficult balance but one we have to be aware of as patients from one part of the world with one type of antibiotic over-usage fly into other parts with a different type of bacterial resistance problem for treatment of their diabetic foot lesions.

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