Prevention and Treatment of Foot Infections
Loss of sensation in the feet is the number one cause of foot amputations among patients with diabetes. Stubbing a toe or cutting the skin can go unnoticed in the absence of pain. Infection in an area with decreased circulation can go untreated for too long ending up in loss of toes, foot, and even the leg. In fact, two-thirds of all nontraumatic leg amputations are done on patients with diabetes.
Prevention and management of foot infections is essential to avoid serious complications requiring amputation. In this article, five physicians from the University of Pennsylvania apply their combined knowledge and expertise in discussing the diagnosis and treatment of foot and ankle infections.
Although diabetes is the number one cause of foot infections, such infections are also associated with other systemic conditions such as chronic kidney or liver disease, gout, and peripheral vascular disease. Anyone whose immune system isn't responding well (we say they are immunocompromised) for any reason are also at increased risk for foot infections. The immunocompromised include the elderly, anyone taking immunosuppressant medications for rheumatoid arthritis or organ transplantation, AIDS patients, cancer patients, and anyone who is malnourished (alcoholics, people with eating disorders or chronic diseases).
Anyone with diabetes or any of these other conditions must be instructed in proper foot care. Inspecting the feet daily called surveillance is essential. Any areas of redness, swelling, bruising, or blistering must be evaluated by a physician. Recognizing signs of infection early and getting proper treatment (usually antibiotics) is the first tool against loss of limb.
The physician will be able to order lab tests and appropriate imaging studies to detect infection, evaluate the patient's diabetic status, and look for fractures, dislocations, or other degenerative changes. Treatment to address those problems is important, too. When skin and nail bed infections have gone too far and abscesses are present, surgery might be needed.
One goal of treatment is to prevent the infection from spreading up the leg. If the infection enters the lymphatic or circulatory systems, total body toxicity can develop with organ failure and even patient death as the final outcome. The immunocompromised condition of many patients who develop limb- and life-threatening infections prevent them from recovering without medical assistance.
The authors offer a separate section in their article dealing with diabetic ulcers and diabetic foot infections. Again, prevention is the key to optimum care for these individuals. Besides skin inspection, proper footwear, use of orthotics when appropriate, and exercise are mainstays of prevention and management.
A physical therapist is often the healthcare professional who addresses many of the components of patient education and prevention related to skin surveillance, proper skin care, foot alignment, posture, and exercise. When infection, deep infection, and/or septic arthritis (joint infection) develop, treatment shifts to the physician and a more medical approach with diagnostic testing, use of antibiotics, and possibly surgery.
The authors conclude that with more than 18 million Americans who already have diabetes and millions more who are either pre-diabetic or who have undiagnosed diabetes, the need for prevention and proper management is more important than ever. This includes the topic of their article: foot infections that can cause serious disability, loss of limbs, and even death.
Oke A. Anakwenze, MD, et al. Foot and Ankle Infections: Diagnosis and Management. In Journal of the American Academy of Orthopaedic Surgeons. November 2012. Vol. 20. No. 11. Pp. 684-693.