Are you concerned about your foot? Any small wound can be a cause for concern if you have diabetes. “Foot infections in persons with diabetes are a common, complex, and costly problem,” writes Benjamin A. Lipsky of the Veterans Affairs Puget Sound Health Care System. “In addition to causing severe morbidities, they now account for the largest number of diabetes-related hospital bed-days and are the most common proximate, non-traumatic cause of amputations,” he adds. The best approach for diabetic foot infections is to get in to have your foot check out by a multidisciplinary team right away!
Step 1: Obtaining Cultures
Not all foot wounds are infected. It is a mistake to simply prescribe antibiotics based on a hunch, so the first course of action will be to ask you a few questions about your ulcer and to probe further. “Deep tissue samples from the ulcer and/or blood cultures should be taken before, but without delaying the start of antibacterial treatment in limb and life-threatening infections,” according to Edward B. Jude from Tameside General Hospital in Lancastershire, UK. He adds, “In milder infections wound sampling may direct appropriate antibacterial treatment.”
Diabetic foot infections are classified as follows:
- Not Infected – No signs of pus, inflammation, pain, tenderness, or warmth
- Mild – Pus and inflammation, but only on superficial tissues — and no other symptoms
- Moderate – Pus, inflammation, cellulitis of >2 cm, deep tissue abscess, gangrene, muscle/joint/bone infection
- Severe – Pus, inflammation, metabolic instability, confusion, vomiting, hyperglycemia, acidosis
Staph infection is the most common type of diabetic foot infection seen, but e. coli and MRSA are sometimes also discovered. The type of bacteria, as well as the severity of the infection, will dictate treatment. Researchers from the New Jersey Medical School report that a non-infected ulcer may be treated with hyperbaric oxygen therapy, specialized footwear, the prescription drug Becaplermin, or a custom cast that relieves pressure from the wound to promote faster healing.
It may sound terribly unpleasant to imagine a sample being taken from an already painful wound, but it will just be a quick scrap or swab and you will hardly feel a thing! It is the only proper way to determine the best course of action for your treatment.
Step 2: Diagnostic Imaging
In addition to checking out your foot wound, a good doctor will take a moment to assess other conditions that may contribute to your problem. Diagnostic imaging will provide vital clues about Peripheral Artery Disease (PAD) and Peripheral Neuropathy. An external Doppler probe will check the blood pressure on your ankle while resting. Sometimes the doctor will ask you to walk to test further. To assess for neuropathy, the doctor will check your touch, vibration and pressure sensations using cotton wool, a tuning fork and a nylon monofilament. These tests are painless and routine. A scan of the foot will reveal any abnormalities in the bone, the presence of foreign bodies, or any soft tissue gas present.
Step 3: Diabetic Foot Infections Treatment
Treatment for diabetic foot infections may include:
- Antibiotics – For infections, oral antibiotics are most common. Mild infections may include topical treatment.
- Surgery – Severe infections may include a deep incision, debridement, or emergency amputation.
- Metabolic Stabilizing – Your other medications may need to be adjusted during your treatment as well.
Step 4: Wound Management
We’ve spoken with many doctors who say patient compliance is their biggest challenge in managing these wounds or preventing a recurrence. Keeping the feet free from infection involves limiting contact with bacteria, monitoring the feet each day for new developments, and finishing any prescribed medication. Part of the reason we developed the SteriShoe® UV shoe sanitizer is to help diabetic patients kill off up to 99.9 percent of the bacteria they are harboring in their shoes. There is no guaranteed way to prevent contact with harmful microbes since they are so abundant in our environment, but we can still do our best to reduce exposure, build-up and the environments where they thrive.