Puncture wounds in the diabetic foot: importance of X-ray in diagnosis

It is well recognised that septic sequelae of puncture wounds are worse in diabetics. Since much of the spreading foot sepsis from puncture wounds is deep to the deep fascia, and because the sole of the foot has thick skin and subcutaneous fibrous septae, crepitus is not as easily appreciated as it is at other sites. Also the rubor of the inflammatory response is minimal in subfascial sepsis and it is therefore easy to underestimate the extent of deep gangrene. The absence of pain due to neuropathy also masks the inflammatory reaction and makes a foreign body or severe osteomyelitis less obvious clinically. These cases demonstrate the value of routine and early radiographs in the assessment of puncture wounds in diabetic feet.