Ulcerated 3

A 57 year old man presents with a painless ulcer of the left foot, which occurred after an episode of minor trauma 3 months ago.

He was diagnosed with type 2 diabetes 5 years ago, for which he is on maximum doses of Metformin and Gliclazide.

An HbA1c performed 2 weeks ago was 9.9%

Select Relevant Investigations
Monofilament test

Performed

Five sites are tested per foot - all of them are negative for sensation.
Handheld Doppler Lower Limbs

Performed

All peripheral pulses are present.
X-Ray L/foot

Performed

The x-ray appears normal, with no evidence of osteomyelitis.
Wound swab + culture

Performed

Cultures are positive for Staphylococcus epidermidis.

Select Relevant Management
Wound Debridement
Antibiotics
Saline dressings
Pressure stockings