Images in clinical medicine. Evolution of a diabetic foot infection.

An obese 50-year-old man with no known medical history presented with a necrotizing infection of his right foot that had begun 10 days previously with lesions that he attributed to wearing new shoes. He was found to have diabetes with peripheral neuropathy. An obese 50-year-old man with no known medical history presented with a necrotizing infection of his right foot that had begun 10 days previously with lesions that he attributed to wearing new shoes. He was found to have diabetes (glycated hemoglobin level, 10.5%) with peripheral neuropathy; he was afebrile, without leukocytosis or radiographic evidence of bone involvement in his right foot. The patient had photographed the lesion twice daily, thinking it would heal spontaneously (Panel A). The preoperative photographs show erythema (day 1), blisters (day 3), a necrotizing abscess (day 6), and wound infection requiring surgery (day 10). The patient ...