Benjamin A. Lipsky, M.D., FACP, FIDSA
Medical Service, VA Puget Sound Health Care System
Department of Medicine, University of Washington, School of Medicine
Washington State, USA

Introduction
Selecting appropriate empiric antimicrobial therapy for diabetic foot infections requires knowing the likely etiologic agents, and assessing the seriousness of the infection¹. Initial therapy is usually empiric, while definitive therapy is based on the results of culture and sensitivity tests, as well as the clinical response to empiric therapy.  

Dr. Alastair Younger, M.D., MB ChB FRCSC
Head, BC's Foot and Ankle Clinic,
Providence Health Care,
And Clinical Associate Professor,
Division of Lower Limb Reconstruction and Oncology,
Department of Orthopaedics,
University of British Columbia,
Vancouver, BC

Diabetic foot disease usually sends an orthopaedic surgeon running. The usual response to a consult is "Call me when they need a below-knee amputation" as the surgeon disappears back to a busy and safe practice of joint replacements, arthroscopy and trauma. Diabetic feet are messy and infected, and the patients non-compliant with a multitude of other me-dical complaints. These problems are often saddled on the orthopaedic surgeon as the medicine service transfers the care after any procedure.  

Dr. Alastair Younger, M.D., MB ChB FRCSC
Head, BC's Foot and Ankle Clinic,
Providence Health Care,
And Clinical Associate Professor,
Division of Lower Limb Reconstruction and Oncology,
Department of Orthopaedics,
University of British Columbia,
Vancouver, BC

In any other joint, bone or part of the body, a displaced intra-articular fracture with malalignment is considered a surgical problem. It would seem logical that restoration of heel height, prevention of nerve and tendon entrapment, restoration of the normal anatomy of the heel cord, restoration of the normal contour of the foot and contact characteristics, and preservation of the joints by anatomic reduction would result in a better outcome for these fractures.  

Richard E. Buckley, M.D., FRCSC
Foothills Medical Center
Calgary, AB

I always get asked about the discussion of the nonoperative side of calcaneal fractures (never the operative side). This is not a problem because I have treated many hundreds of patients nonoperatively with calcaneal fractures. Since the results of our large prospective randomized multicentre controlled clinical trial have been published, we have been able to provide better care for patients, as we have taken some good steps in the management of os calcis trauma¹.