A 62-year-old diabetic presents with a Wagner Grade 3 foot ulcer: a deep ulcer penetrating to tendon and joint capsule over the first metatarsal head with no systemic sepsis. The recommended management step (after appropriate debridement) is:
- A Total contact casting alone after debridement
- B Transmetatarsal amputation
- C Systemic antibiotics targeting MRSA and Gram-negative organisms plus vascular assessment ✓
- D Split-thickness skin graft application
Explanation
Wagner Grade 3 diabetic foot ulcers involve deep infection reaching tendon, joint capsule, or bone (early osteomyelitis). Management requires: (1) broad-spectrum antibiotics covering polymicrobial organisms including MRSA and anaerobes, (2) vascular assessment (ABI, Doppler) to evaluate ischemia, and (3) thorough surgical debridement. Adequate perfusion is essential for healing; without it, even optimized antibiotics and wound care will fail. Total contact casting is appropriate for Grades 1–2 neuropathic ulcers without deep infection. Amputation is reserved for failed salvage.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.