In diabetic patients with wounds in the foot and ankle, wound healing is stuck in the inflammatory phase. The presence of chronic infection on the wound surface, which is filled with a large amount of proteins and growth factors, are factors that keep the wound in the inactive phase. Local and global factors prevent the transition of the wound from a chronic inflammatory to an acute state (a state that plays an active role in the normal wound healing process). Ulcers are carefully assessed by measuring their area and depth, area = long axis of ulcer * wide axis, depth is assessed by the level of soft tissue involved in the ulcer: epidermis, dermis, subcutaneous fat, deep fascia, muscle, tendon, joint capsule, joint and bone. A metal probe helps to determine the depth of the ulcer, and if bone is probed, the incidence of osteomyelitis is up to 85%. If the tendon is involved, the infection will most likely spread to the proximal or distal end of the tendon, and the surgeon should carefully examine the distal and proximal segments of the suspected tendon sheath. If there is a greater likelihood of distal to proximal spread of infection, the proximal tendon sheaths that are susceptible to spread (e.g., extensor support band, ankle canal) should be examined. Photograph the ulcer at the same time. If cellulitis is present, the erythematous border should be traced and recorded (to the exact month, day, and time) in colorfast ink. After deep tissue culture and administration of broad-spectrum antibiotics, the erythema is monitored uninterruptedly for enlargement and elimination of the leg. If insufficient antibiotics are administered, or if the wound is not adequately debrided, inflammation can cross the boundaries traced by the inkblot after 4-6 hours. It is important to distinguish cellulitis from redness caused by chronic ulcers and chronic ischemia. If the erythema disappears after elevating the affected limb above the plane of the heart, the erythema is subordinate, usually not due to inflammation, and the skin may appear wrinkled. If the erythema persists and there is cellulitis around the wound, antibiotic therapy with or without surgical debridement is required. Subordinate erythema can also occur after the initial surgery and should be differentiated from postoperative cellulitis. Local blood flow is assessed by palpating the arterial pulses and using portable arterial Doppler. If the anterior and posterior tibial arteries can be palpated, this indicates adequate blood flow. If one arterial fluctuation cannot be palpated, the arterial Doppler should be used for evaluation, with a triphasic Doppler signal suggesting normal flow, a diphasic Doppler signal suggesting inadequate flow, and a single one requiring further study. If poor flow is suspected, Doppler must be performed. If the flow is inadequate, an angiologist (specializing in angioplasty operations) should be consulted.