Neuropathic foot

In the neuropathic foot, operative debridement is almost always indicated for wet gangrene. The main principle of treatment is surgical removal of the necrotic tissue, which may include toe or ray amputation (removal of toe together with part of the metatarsal) or, rarely, trans-metatarsal amputation.

Although necrosis in the diabetic foot may not be associated with a definite collection of pus, the necrotic tissue still needs to be removed.

Fig. 6.13 Wet necrosis of the hallux with cellulitis spreading up the foot. There was no collection of pus but extensive sloughy tissue was present and he underwent amputation of the 1st ray.

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