This is a patient of mine who have had toes amputated from infected foot ulcers before, so unfortunately he already knew that he has a bad infection in his foot.
The knuckle underneath the third toe is exposed and there is pus deep within his foot, making his third toe very swollen. It is possible to save the third toe, but when the knuckle is infected, trying to save the toe bones will likely require long term IV antibiotics. The small toes are not that important for walking, so we agreed on a third ray amputation (an amputation of the third toe and the knuckle attached to it, also known as the metatarsal). With infection control surgery, I cannot see bacteria, I can only see the “footprints”. They take many forms, typically in the form of pus, liquefied tissue, or blood vessels clots, so all of these will be removed, but sometimes a few bits of bacteria are still hiding somewhere. Closing the wound when there is still bacteria in the body puts the patient at risk for having another infection, so this is why sometimes I stage the surgery, the first one is to remove infection and leave the wound open. The second surgery will be to remove any remaining infection, and if the wound looks clean, I will close it with sutures. In the photo below, I used a wound vac after surgery to get the deeper tissues to heal a little bit faster. After 3 weeks of non-weight-bearing, the sutures were removed, and he was allowed to walk in regular shoes.