Essential #5 of Your Diabetic Foot Team: Be Prepared to Surgically Drain Infection or Remove Gangrene.

In these discussions, we discuss each of the 7 essential skills that your diabetic foot treatment must possess. As an educated patient you will be able to evaluate the competency of your treatment team. Having a competent team will help you prevent an amputation related to your diabetes.

Today we will discuss essential skill number five:

5. If necessary, be prepared to surgical drain any infection or surgically remove any dead tissue (gangrene) at the bedside (debridement).

This is a topic that is not for the squeamish. So prepare yourself.

All amputations in diabetic patients start out as some type of foot infection. The foot infection becomes worse, the bacteria rages out of control, and gangrene sets in. Gangrene is a scary term but simply means death of tissue. Dead tissue happens to be a fabulous medium for bacteria.

This skill is the one most typically referred to as “limb salvage.” If you look up the word “salvage” in the dictionary, you will find “property saved from destruction in a calamity (as a wreck or fire).”

Only by aggressively removing infected and dead tissue can the destruction of a diabetic foot infection be halted.

Emergency surgery is very common in treating diabetic foot infections. The very best way to treat a bad diabetic foot infection is by physically removing the infection…not by giving antibiotic pills. This means opening any area of infection to remove all of the bacteria. The infected compartment of the foot has to be irrigated. This is in addition to antibiotics, not instead of antibiotics.

Your team must be prepared to perform emergency surgery if the infection is bad enough that it is deemed a “limb threatening infection.” You have to keep in mind that the diabetic patient has an immune system that is weak. Because of this one is often unable to fight off an infection.

You have to also remember that poor circulation in the feet and legs (called peripheral arterial disease) is very common in diabetics. Most people with diabetes who are at high risk of a diabetic foot or leg amputation suffer from problems with the circulation in their legs and feet. Any antibiotics are delivered through the bloodstream. So poor circulation means poor delivery of the infection fighting antibiotic drugs.

In 2005, there was a research paper published in medical journal that discussed the risk of hoping to avoid surgey in diabetic foot infections. The article was entitled “Osteomyelitis of the Foot and Toe in Adults Is a Surgical Disease Conservative Management Worsens Lower Extremity Salvage.”

Osteomyelitis is the medical term for a bone infection. The point of this paper was to stress to physicians that hoping for the best and just giving antibiotics does not work. In fact, as the title suggests, that actually makes things worse. Surgery is necessary in order to save a leg from a diabetic foot infection.

Diabetes is a scary disease. Diabetic foot infections likewise can be simple or complicated. In either case, an evaluation is warranted given the potential for the loss of a limb. This should never be taken lightly. Keep in mind that most diabetic foot ulcerations do not need to end up as an amputation.

Although all of this talk about surgery, infections, gangrene and amputations can certainly be alarming, you should remember that your diabetic treatment team is on your side. As long as they are vigilant, you should be able to avoid any of these complications. Make sure you get an evaluation early whenever you notice an open sore. And if necessary, evaluate your team based on these criteria.

Diabetic foot amputation is preventable. Live long and enjoy your life!


Dr. Christopher Segler is an award winning diabetic foot specialist. Although he has performed diabetic foot amputations, he still believes that diabetic foot amputations result from the dismal performance of a failing health care system that prevents adequate patient education. It is his passion to teach strategies that can stop diabetic amputations. You can learn more by requesting your FREE report “No Leg Left To Stand On: The Secrets Insurance Companies Don’t Want You To Know About Diabetic Foot Amputation” at http://www.ineedmyfeet.com.