Diagnosis

Cleanse and debride wound(s) before obtaining specimens for culture.

Obtain a tissue specimen for culture/biopsy by scraping from the ulcer base with a sterile scalpel or dermal curette. Avoid swabbing non-debrided ulcers or wound drainage.

Ulcer floor should be probed carefully. If bone can be touched with a metal probe then the patient should be treated for presumed osteomyelitis with antibiotics in addition to possible surgical debridement.

A deep foot-space infection can be present. Consider imaging to look for deep infections.

Putrid discharge is diagnostic for the presence of anaerobes.

MRI is more sensitive and specific than other modalities for detection of soft-tissue lesions and osteomyelitis.