Indicators for frank infection will also include pain (especially in the neuropathic patient), erythema, and induration. When bone or joint is visible or palpable at the depth of the ulcer, osseous infection becomes more likely (285, 423). A thorough discussion of the management of infected wounds is presented later in this document and summarized in Pathway 4. Unrecognized ischemia will also impair wound healing and must be diagnosed prior to development of infection or ischemic necrosis of the ulcer. When no progress or enlargement of the wound has taken place, re-examination of the vascular status of the extremity is warranted.
