Lesson 1Focused history elements: hyperglycaemia, duration of ulcer, prior ulcers or amputations, systemic symptomsLearners will identify key history elements for suspected diabetic foot infection, including ulcer onset, prior wounds or amputations, systemic symptoms, glycaemic control, and recent antibiotics, to estimate severity and guide urgent investigations in hospital.
Characterising ulcer onset and durationPrior ulcers, amputations, and surgeriesRecent trauma, footwear, and pressure historySystemic symptoms and sepsis red flagsMedication, antibiotic, and allergy reviewLesson 2Initial in-hospital management in first 24 hours: empiric antibiotics, culture technique, offloading strategies, dressing choices, glycaemic control coordinationLearners will structure the first 24 hours of in-hospital care, covering empiric antibiotic selection, proper culture techniques, urgent offloading, dressing choices, pain control, and coordination of glycaemic management with the inpatient team in New Zealand hospitals.
Risk-based empiric antibiotic selectionObtaining deep tissue and bone culturesImmediate offloading and bed rest ordersSelecting initial dressings and topical careCoordinating insulin and glycaemic controlLesson 3Laboratory and imaging: CBC, CRP, blood cultures, HbA1c, plain radiographs, MRI indications and useThis section explains appropriate laboratory and imaging workup, including CBC, CRP, ESR, blood cultures, HbA1c, plain radiographs, and indications for MRI, CT, or ultrasound to detect osteomyelitis, abscess, and gas in soft tissues in diabetic patients.
Baseline inflammatory and sepsis labsRole of HbA1c and metabolic markersPlain radiographs and typical findingsMRI indications for osteomyelitisWhen to use CT or ultrasound imagingLesson 4Pathophysiology of diabetic foot infection and neuropathic ulcerationThis section reviews the mechanisms leading to neuropathic ulceration and infection in diabetes, linking hyperglycaemia, neuropathy, ischaemia, and impaired immunity to clinical patterns that guide risk assessment and treatment decisions in hospital care.
Impact of chronic hyperglycaemia on tissuesPeripheral neuropathy and loss of protectionMicrovascular and macrovascular ischaemiaImmune dysfunction and infection riskBiofilm formation in chronic foot woundsLesson 5Coordination with endocrinology, infectious disease, vascular surgery, and wound care teamsLearners will understand how to coordinate care with endocrinology, infectious disease, vascular surgery, and wound care teams, defining roles, referral triggers, and communication strategies to optimise outcomes and reduce complications in New Zealand settings.
When to involve endocrinology servicesConsulting infectious disease specialistsReferral criteria for vascular surgeryWorking with wound care and podiatryStructured multidisciplinary case reviewsLesson 6Focused foot and lower-limb exam: probe-to-bone, depth, sinus tracts, neuropathy testing (10g monofilament), peripheral pulsesThis section details a structured foot and lower-limb exam, including inspection, palpation, probe-to-bone testing, depth and sinus tract assessment, neuropathy screening with 10 g monofilament, and vascular evaluation with pedal pulses in hospital patients.
Systematic visual inspection of the footProbe-to-bone technique and interpretationMeasuring wound depth and sinus tracts10 g monofilament neuropathy testingPalpation and grading of pedal pulsesLesson 7Discharge planning: outpatient wound care, offloading devices, footwear prescription, glycaemic follow-upLearners will plan safe discharge for patients with diabetic foot infection, including outpatient wound care arrangements, offloading devices, footwear prescriptions, glycaemic follow-up, education on warning signs, and criteria for early return in New Zealand.
Assessing readiness and safety for dischargeCoordinating outpatient wound care visitsPrescribing offloading devices and footwearScheduling diabetes and glycaemic follow-upPatient education on recurrence preventionLesson 8Wound classification systems and severity scoring (IDSA, IWGDF, University of Texas)Learners will compare major wound classification and severity scoring systems, including IDSA, IWGDF, and University of Texas, and apply them to stratify risk, standardise documentation, and guide level of care and treatment intensity in hospitals.
IDSA infection severity categoriesIWGDF risk and infection gradingUniversity of Texas wound stagingLinking scores to treatment pathwaysUsing scores for communication and auditLesson 9Criteria and timing for surgical debridement or amputation and perioperative considerationsThis section outlines criteria and timing for surgical debridement or amputation, including indications, urgency levels, perioperative optimisation, anaesthesia considerations, and postoperative limb salvage and rehabilitation planning in inpatient care.
Indications for urgent surgical debridementCriteria for limited versus major amputationPreoperative risk assessment and optimisationAntibiotic timing around the operationPostoperative wound and limb salvage plansLesson 10Wound care protocols, antimicrobial stewardship, serial assessment and documentationThis section presents standardised wound care protocols, dressing selection, debridement intervals, antimicrobial stewardship principles, and methods for serial assessment, photography, and documentation to monitor healing and guide changes in hospitals.
Standardised bedside wound assessmentChoosing dressings by exudate and depthFrequency and methods of debridementAntibiotic de-escalation and durationSerial photography and EMR documentation
