Diagnosis and management of the diabetic foot ulcer.

Infected leg ulcers in patients with diabetes mellitus are a common and potentially serious problem. Neuropathy and vascular disease associated with diabetes mellitus allow the possibility of significant microbial invasion. Infections in diabetic patients are usually polymicrobial reflecting the normal flora of the foot skin. Curettage of the base of foot ulcers and deep tissue cultures are the most reliable methods for identifying the true pathogens, which are aerobic Gram-negative bacilli, anaerobes, and Staphylococcus aureus. Empirical antibiotic therapy should be directed against these pathogens. Once culture and sensitivity results are available, therapy should be targeted specifically for the pathogens present to prevent long-term use of broad-spectrum antibiotics. Preventive care of the foot in patients with diabetes mellitus is extremely important and may reduce complications associated with infections of the foot.