Introduction
Patients with diabetes are very prone to develop infections and ulcers of their feet. This happens because diabetes causes damage to the nerves, muscles and blood vessels in the feet and legs.
Diabetic patients are more prone to infection. This combined with damage to the underlying tissue leads to ulceration which in turn can progress to rapid and severe infection extremely quickly. There is a high risk for extensive damage which can cause osteo-myelitis (infection of the bone). Osteo-myelitis often requires amputation to prevent ongoing damage and infection.
Causes
Diabetes has a number of effects on the feet:
- Circulation – diabetes increases the risk of arterial disease and poor blood supply. Reduced blood supply leads to fragile tissues at higher risk of ulceration and poor healing of any tissue damage.
- Sensory loss – diabetes affects the nerves in the feet, reducing sensation and increasing the risk of injury. There is an increased risk of trauma, including from poorly fitting shoes.
- Foot deformity – nerve damage from diabetes causes change in sensation, but also affects nerve supply to muscles that leads to an alteration in the shape of the foot. This increase the risk of pressure ulcers and subsequent infection.
Symptoms
Diabetic foot ulcers usually present with infection and are often quite advanced by the time they are detected.
Symptoms include:
- Fever.
- Pain.
- Rigors.
- Ulceration.
- Gangrene.
- Redness or erythema.
- Wound discharge.
- Offensive smell.
- Generally feeling unwell.
- Increase in blood sugar levels.
Tests
A variety of tests are performed to manage diabetic foot infections, including:
- Blood tests.
- Blood sugar levels.
- X-ray.
- Ultrasound.
- MRI.
The aim of investigations is to assess the severity of infection, the risk of osteo-myelitis and the adequacy of blood flow.
Diagnosis
Confirmation of the presence of a diabetic foot infection is based on physical assessment and appropriate investigations.
Treatment
The management of diabetic foot ulcers is complex and varied.
The degree of infection, underlying medical issues and the presence of bone infection or poor blood flow all influence management. Options include:
- Antibiotics – oral or intravenous.
- Bed rest and elevation.
- Debridement – surgical removal of infected tissue.
- Amputation – toe or in severe cases the leg may require amputation to prevent life threatening infection.
- Restoration of blood flow – to help control infection and facilitate wound healing. Includes angioplasty, stenting, endarterectomy or bypass surgery.
Related Information
Peripheral Artery Disease
Arterial Bypass Surgery
Peripheral Artery Balloon Angioplasty
Peripheral Artery Stenting
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