Infection in the diabetic foot.

A 56-year-old woman presented with a chronic infection of her right first toe. The woman had a 15-year history of diabetes mellitus and had been insulin dependent for the past five years. Her toe had been injured one month earlier when hit by a frozen chicken that fell out of the freezer. The accident caused a bruise and a small cut. Serous to purulent drainage then developed. When she presented, the toe was reddened and draining. Physical examination showed a nonobese woman with no fever or other evidence of systemic infection. The wound showed no evidence of necrotizing fasciitis. Peripheral pulses were 2+ and capillary refill was slow. Sensation in both feet was decreased. The transcutaneous oxygen tension in the feet was reduced at 20 mm Hg. Relevant laboratory findings included a serum glucose of 250 and creatinine of 1.5. X-rays of the foot were compatible with diffuse osteomyelitis of the distal phalanx of the great toe. Technetium and indium scans were positive, with increased uptake localized to the area of x-ray changes (Figure 1). The patient was admitted to the hospital.