The first week of diabetic foot limb salvage has one purpose: to control the infection, find out what the blood supply can deliver, and turn a dangerous wound into a stable one. That usually means admission, an early operation to clear dead and infected tissue, intravenous antibiotics, tight control of blood glucose with insulin, studies of the arteries, and often more than one visit to theatre. Reconstruction and closure come later. This week is about making the foot safe and gathering the information that decides what is possible.
Day of admission: assessment and getting the infection under control
Admission usually begins with a full assessment rather than a dressing. Expect blood tests including glucose, kidney function, haemoglobin and markers of infection, an X ray of the foot to look for gas in the tissues and for bone changes, examination of pulses and sensation, and gentle probing of the wound to see how deep it goes. If you are unwell with fever, fluids and antibiotics start straight away.
Antibiotics at this stage are chosen to cover the likely organisms. Deep tissue samples are taken in theatre rather than relying only on a surface swab, because a swab often grows organisms sitting on the surface rather than the ones causing the deep infection. Once cultures come back, usually later in the week, the antibiotics are narrowed to what is actually needed.
The first operation: clearing what cannot be saved
If there is spreading infection, pus, gas or dead tissue, surgery happens early, sometimes within hours. This first operation is not a reconstruction. It is a clearance, and the aim is to open the infected spaces, drain pus, remove dead skin, fat, tendon and bone, and leave healthy bleeding tissue behind. Wounds are left open rather than stitched, because closing an infected space traps infection.
People are often shocked at how much larger the wound looks afterwards. That is expected. A small opening on the surface frequently hides a much bigger cavity underneath, and the wound has to reveal the true extent of the problem before it can start healing. If a toe or part of the forefoot is beyond saving, removing it at this stage is sometimes what protects the rest of the foot.
Blood sugar, insulin and the rest of your health
Expect your usual diabetes medication to change. Most people are put on insulin during an acute infection, often with frequent glucose checks, because tablets alone rarely hold control when infection and surgery are pushing sugars up. This is usually temporary, and the plan for going home is reviewed before discharge.
The rest of your health gets attention too, because it affects healing. Kidney function matters, especially if contrast is needed for angiography. Anaemia, low protein and poor nutrition are corrected where possible. Heart disease is assessed if surgery is planned. Smoking is discussed frankly, since it narrows the small vessels that the foot depends on. You may meet a physician, a diabetes nurse, a dietitian and a physiotherapist as well as the surgical team.
Circulation studies and what they decide
Somewhere in the first week the arteries are studied properly, with Doppler ultrasound, ankle and toe pressures, and often a CT angiogram or catheter angiogram. This is the single most important piece of information in limb salvage, because a wound in a foot without adequate blood flow will not heal whatever else is done.
If a narrowing or blockage is found and can be treated, angioplasty or bypass may be arranged with vascular colleagues, sometimes in the same week. If flow improves, the outlook for the wound changes substantially. If the arteries cannot be reopened, that is difficult news, and it is discussed honestly rather than glossed over, because it changes what can realistically be offered.
Repeat visits to theatre and dressings
It is common to go to theatre more than once in the first week. Infection declares itself over days, and tissue that looked borderline at the first operation may be clearly dead at the second. Planned repeat clearance is a normal part of good treatment and is not a sign that the first operation failed.
Between operations the wound may be managed with regular dressings or with negative pressure therapy, a sealed dressing attached to a pump that removes fluid and encourages the wound bed to fill in. It looks unusual and it is generally well tolerated. Ask the nurses to explain the alarm sounds and what to do if the seal leaks.
Staying off the foot
Pressure is the enemy of a healing foot wound. From the beginning you will be asked to keep weight off the affected foot, using bed rest with the heel protected, a special boot, a cast, crutches, a walker or a wheelchair. Physiotherapy starts early to keep you moving safely, protect the other foot and prevent chest problems and clots after surgery.
The other foot deserves attention too. Heels are protected with cushions, because pressure sores develop quickly in a person who is unwell, diabetic and largely in bed. Many people are surprised to be told that the good foot is at risk as well, but it is.
The honest conversation
At some point in the first week, usually once cultures and circulation studies are available, the team should sit down with you and your family and explain what has been found. That conversation covers how much tissue has been lost, whether blood supply can be improved, whether bone is infected, what closure might eventually involve, and whether keeping the foot is a realistic goal.
It is important to hear this plainly. Salvage is attempted whenever it is reasonable, and many feet do heal. Some do not. If infection has destroyed the deep structures, if the arteries cannot be reopened, or if repeated surgery is unsafe for your general health, amputation at some level may be the safer route, and for some people it restores walking sooner than a long series of operations that does not succeed. Nobody should promise you a saved limb before examination and circulation studies, and a plan that is reviewed as things change is more trustworthy than a promise.
What the end of the first week usually looks like
By around the seventh day, many people have had the infection brought under control, have a wound that is clean and no longer smells, are on targeted antibiotics, have their glucose managed with insulin, have had their arteries studied and possibly treated, and have a plan for the next stage. Some are ready to go home with dressings and a clear follow up plan. Others stay longer for further surgery, for antibiotics through a drip, or while waiting for a vascular procedure. Both paths are normal. Ask your team what your particular milestones are, and ask what symptoms should bring you straight back.
