A little bit about Infections of Feet in Diabetic Patient and their Management
Mostly it is caused by the combination of microvascular complication reducing the blood flow to the effected foot and peripheral neuropathy making foot insensible to the pain.
It could be
Cellulitis -
warm, tender skin lesions that is mostly a clinical diagnosis which responds well to Antibiotics
Deep Skin & Soft tissue Infections -
Its a painful skin lesion in which patient would appear extremely ill, in case of severe tenderness and pain always suspect of underlying compartment syndrome / gas gangrene.
It could be due to combination of multiple organisms. Radiological diagnosis is indicated that would involve x ray, CT or if available MRI.
Start with empirical antibiotic therapy covering gram positive and anaerobes and shift to culture specific antibiotics as soon the culture results are back and early debridement of the tissue is indicated along with surgical intervention for compartment syndrome.
Osteomyelitis -
Patient would be febrile and painful at the site of the bone along with foul smelling discharge.
X ray findings would only be evident only after first week of infection which would include soft tissue swelling and periosteal elevation to start with.
Antibiotic treatment as soon the localised tenderness and swelling along with fever is observed followed straight away by surgical debridement and amputation.
Education of the patient about foot care, looking after feet more so than his face.
Daily complete general look around the feet and between the toes looking for redness, swelling, skin break.
Daily use of moisturisers, selecting shoes with appropriate size that are not too tight wearing them daily for small periods of time before regularly wearing them to prevent himself from new shoes ulcers.
Carefully trim the nails along the shape of the toe and remove any sharp edges.
Encourage the patient for regular follow up with a diabetes foot care specialist as recently it has been found that 5 years mortality rates are as high as 39% to 80% in a patient of diabetes who had an amputation done. That’s an alarming figure !