Diabetic%20foot%20infection Management

Foot Care

• Educate patient on proper foot care
  • Foot ulcers should be detected & treated early; encourage daily foot inspection
• Have a regular foot examination & evaluation of amputation risk at intervals of 1-3 months
• The IWGDF recommends the following frequency of clinic visits for the prevention of foot ulcers based on ulcer risk:
  • Very low: Annually
  • Low: Every 6-12 months
  • Moderate: Every 3-6 months
  • High: Every 1-3 months
• Have a regular callus debridement
• The use of professionally fitted therapeutic footwear is recommended for the following:
  • High-risk patients w/ diabetes
  • Diabetic patients w/ severe neuropathy, foot deformities or amputation history
  • Patients w/ healed diabetic foot ulcer
• Pressure-relief devices that cannot be removed are associated w/ faster healing ulcers than are removable devices as per clinical trials 
• If indicated, consider referring patients to foot care specialists for preventive care & further vascular evaluation

Lifestyle Modification

• Glycemic & blood pressure control
• Smoking cessation

Further Assessment

• Evaluate surgical interventions as indicated
• In selected patients w/ an active foot ulcer that has not responded to nonsurgical treatment, foot surgery can effectively reduce the risk of recurrent plantar & nonplantar ulcers
• Specialist referral should be considered in patients needing further management of deformities, peripheral artery disease & neuropathy

• Mild diabetic foot infections’ signs & symptoms that have been given appropriate treatment almost always resolve without the need for amputation
  
  • In >80% of cases, long-term control of infection is achieved

• Infections involving deep soft tissue structures or bone often have less favorable outcome & many require surgical debridement, bone resection or partial amputation
• Lower extremity amputation rates may reach 50-60% in patients w/ extensive infection or in medical centers w/ limited expertise or resources
• For hospitalized patients, even in expert centers, almost half of the patients have poor outcomes or will have amputations
• Most amputations can be foot sparing (ie below the malleoli) in the hands of any experienced surgeon
• Presence of limb or foot ischemia can synergize w/ infection that worsen prognosis
• For a patient w/ diabetic foot ulcer, the risk of death at 5 years is 2.5 times as high as the risk for a patient who does not have a foot ulcer
• There is a high likelihood that having had one foot infection can also infect the other
  
  • There is a 20-30% recurrence of diabetic foot infection especially in those w/ underlying osteomyelitis

• Evidence of remissions includes a decrease in the erythrocyte sedimentation rate, destroyed bone reconstitution on plain radiograph & healing of any overlying soft tissue wound
• Early signs of skin damage, ie abundant callus, blistering or hemorrhage, are among the strongest predictors of ulcer recurrence
• Within a year after ulcer healing, there is roughly 40% chance of having recurrence, almost 60% in 3 years & 65% within 5 years