Figure 1.

Infected ulceration of the lateral edge of the right foot in a man with diabetic Charcot neuro-osteoarthropathy (with previous amputations of both great toes). Note the collapse of the midfoot, with consequent pressure-related ulcerations, a long-standing clinical problem. The ulcer on the lateral foot recently became infected and was found to have underlying bone involvement. As shown in this photograph, the manifestations of infection in a diabetic foot ulcer may be minimal at the beginning, but can progress rapidly. There is somewhat more pronounced erythema and induration proximal and dorsal to the ulcer. The patient noticed new pain at the site and a sudden change in the color of the foot. He had no fever or visible purulent secretions. This case illustrates that: infection in the diabetic foot is almost always due to underlying problems (such as foot deformity or peripheral neuropathy); even deep infection may present with initially relatively minimal signs and symptoms; clinician’s should consider osteomyelitis in every diabetic patient with a foot ulceration. (Photograph obtained with permission of the patient).