Generally infections can be detected by the presence of surrounding cellulites.  Cultures should be obtained from purulent drainage or curetted material from the wound bed.  Palpation of foot pulses should be performed as well as non-invasive Doppler blood flow studies.  Radiographs of extensive ulcers should be performed to assess for underlying osteomyelitis. 

Figure 1: Diabetic Foot Ulcer

Note:  The surrounding callus buildup around the full thickness wound.  Granulation tissue is present at the base of the wound.  Filling the defect with tissue engineered wound matrix would close the wound as well as add important matrix components to stimulate re-epithelialization.

There are several classification systems which describe depth and comorbid factors.  The commonly used Texas Diabetic Foot Wound Classification and the Wagner classification system are presented.

University of Texas Diabetic Wound Classification System

Stage

Wagner Ulcer Classification System