Management of the septic foot is a challenge in diabetic patients, and this condition often progresses to amputation in an effort to alleviate otherwise incurable infection. We designed and followed a protocol for the management of the septic diabetic foot and, after 2 years (May 2004 through June 2006), we analyzed the data related to 31 septic feet of 139 patients. The treatment protocol consisted of blood glucose control, intravenous antibiotic therapy, controlling comorbidities, revascularization, ulcer drainage and irrigation, systematic debridement, dressing changes and wound care, and amputation if necessary. The outcomes of interest were amputation and limb salvage. The analyses showed that frequent drainage and debridement, along with revascularization when indicated and possible, resulted in 4 (12.9%) major (below-the-knee) amputations and 3 transmetatarsal amputations. Of the 7 amputations, 3 were associated with ischemia, 4 with neuropathy, and 1 with neuropathy and ischemia. In follow-up, 1 patient with a prior history of septic diabetic foot required major amputation. Based on these findings, it is concluded that the septic diabetic foot is not necessarily an indication for amputation, and aggressive management by means of metabolic and surgical care can lead to a favorable outcome.
Level of clinical evidence: 2.