Patient handout

Diabetes-related foot disease (ulcer, infection, osteomyelitis)

PRODUCTION

1. Your condition

This handout is for diabetes-related foot disease (ulcer, infection, osteomyelitis). Your care team identified this based on: open ulcer / wound on foot in patient with diabetes (iwgdf 2023).

Other reasons your team may use this plan: foot redness / warmth / swelling — suspected infection (idsa 2012 lipsky); new foot pain or loss of sensation — neuropathy or ischemia (iwgdf 2023); foot x-ray findings of osteomyelitis or charcot (iwgdf 2023).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
cephalexin	500 mg PO QID	PO	q6h × 7–14 days	IDSA 2023 — first-line MSSA/strep coverage
dicloxacillin	500 mg PO QID	PO	q6h × 7–14 days	IDSA — alternative anti-staph penicillin
clindamycin	300–450 mg PO QID	PO	q6h × 7–14 days	PCN-allergic; check local D-test for inducible MRSA resistance
doxycycline	100 mg PO BID	PO	q12h × 7–14 days	IDSA — covers CA-MRSA + good tissue penetration
trimethoprim-sulfamethoxazole	1 DS tab (160/800) PO BID	PO	q12h × 7–14 days	IDSA — covers CA-MRSA; renal dose; SJS warning + warfarin/sulfonylurea interactions

Plan: IDSA / IWGDF 2023 — severity-tiered empirical antibiotic regimen for diabetic foot infection

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — wound healing, no signs of infection

If you have:

Wound size shrinking each week
No new redness, warmth, swelling, or pus
No fever
Glucose at target
Footwear / offloading device worn as instructed

Do this:

Inspect both feet daily (use mirror for plantar surface)
Wear prescribed offloading device for ALL weight-bearing
Wash + dry feet daily (especially between toes)
Apply moisturizer to dry skin BUT NOT between toes
Cut nails straight across; never trim corns/calluses at home
Continue all prescribed medications
Attend every follow-up visit
Glucose monitoring per plan

YELLOW — Caution — early changes, contact wound team

If you have:

New redness, warmth, or swelling around wound
Wound is larger or deeper
New drainage or cloudy fluid
Mild new pain at wound or surrounding area
Glucose persistently elevated
Cannot wear offloading device for any reason

Do this:

Call wound care team / podiatry same day
Continue offloading
Check glucose more frequently
Take photo of wound for clinic visit

Call your provider if:

Any new redness or change in wound appearance
Glucose >250 repeatedly
Cannot adhere to offloading

RED — Medical alert — go to ED now

If you have:

Fever ≥101°F (38.3°C)
Spreading redness up the foot or leg
Foul odour from wound or new discharge
Gas / crepitus / black tissue / new gangrene
Severe pain disproportionate to wound
Unable to keep weight off foot
Confusion, lightheadedness, or other systemic illness
Sudden cold / pale / blue foot (acute limb ischemia)

Do this:

Go to ED immediately
Bring medication list and most recent wound photos / records
Notify your wound care team

Call your provider if:

Any red-zone symptom — go to ED, do not wait

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Systemic signs of infection (fever, hypotension, tachycardia, AMS, leukocytosis) in DFI (IDSA 2012 Lipsky)(life-threatening)
Crepitus, gas in tissue, rapidly spreading erythema, severe pain out of proportion (IDSA 2012 Lipsky)(life-threatening)
Probe-to-bone positive AND MRI / bone biopsy confirms osteomyelitis (IDSA 2012 Lipsky; IWGDF 2023)
Rest pain, non-healing ulcer, gangrene + ABI <0.4 OR TBI <0.3 OR TcPO2 <30 (IWGDF 2023)
Hot, swollen, red foot in patient with neuropathy, often without preceding ulcer; X-ray may show fracture / dislocation (IWGDF 2023)
Severe hyperglycemia, DKA, or HHS in setting of foot infection (ADA 2026)

5. Follow-up

Multidisciplinary clinic q1–4 wk; podiatry + wound care + endocrinology + vascular; preventive education (daily inspection, footwear, hygiene); annual screening (monofilament, ABI/TBI, foot exam); secondary prevention after healed ulcer

6. Sources

Guideline: IDSA / IWGDF 2023 — Diagnosis and treatment of diabetes-related foot infection + IWGDF 2023 prevention/management practical guidelines + ADA Standards of Care 2026 + SVS / ESVS / SCAI 2024 (CLTI) + WOCN 2022