Diabetic%20foot%20infection Management
Prevention
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
Prognosis
- 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