Diabetes & The Body

Foot Infections: The Subtle Attack

Diabetes is the disease, which could be very dangerous if neglected. This disorder has many complications and might turn out to be very serious. People with diabetes, especially those with very high blood glucose levels, have poorer defense against infection. Hence minor cuts and abrasions to the foot that every one gets from time to time can turn into infection. So protect the feet with appropriate footwear. If there is a foot ulcer, the break in skin would also make infection much more likely to occur.

The foot is an especially rich source of bacteria and invading microorganisms, because shoes provide them a perfect environment in which to live. Therefore, any time you notice a lesion, ulcer, cut, or sore on your feet, you need to take prompt action to prevent infection. A foot ulcer is the most likely source of infection in the foot. When an ulcer becomes infected, microorganisms can eat through layers of skin and bone tissue to create a deep hole. When the infection spreads or becomes too deep, amputation may be needed.

Symptoms and Risks

It is essential to distinguish between localized versus generalized foot infection because they require different intensity of treatment.

Localized foot infection is recognized by redness, heat and swelling confined to an area and the foot as a whole is not swollen. Oral antibiotics for a few days can usually eliminate the infection. Due to the neuropathy, the patient may not feel any pain or discomfort when localized foot infection is associated with a neuropathic ulcer. Oral antibiotics are usually satisfactory but may need to be continued until the ulcer has healed.

Symptoms of an infected ulcer include fever, redness, swelling, warmth around the wound, and any sort of drainage or oozing of pus-like material.

An infected ulcer can eat away at your soft tissue and make its way into the bone. If the infection is deep, a part of the foot or even the entire foot or leg may have to be removed to save your life.

In a generalized foot infection, the whole foot is red and swollen. Oral antibiotics in higher dosage can be tried but if there is no rapid response such as within 24 hours, intravenous antibiotics and sometimes surgical intervention are urgently required because there is likely to be infected tissue deep inside the foot.

Onychomycosis is the most common nail infection among people with diabetes. This infection is caused by a fungus and most frequently affects the nail of the big toe. If you can tolerate the unsightly appearance of the toe, it may not seem like that big of a deal. But if left untreated, a fungal toenail can lead to ulceration and infection of the toe itself, which can have serious consequences for someone with diabetes.

And in foot infection complicated by osteomyelitis, there is a risk of the underlying bones being involved. X-ray may show bone destruction in the presence of a foot ulcer. Once there is osteomyelitis, a much higher dose of antibiotics and for a longer period is often required to eradicate the infection. In such conditions quite often, intravenous antibiotic therapy is required and sometimes the infected bones need to be surgically removed to help the foot heal.

Although osteomyelitis in the early phase does not show up on X-ray, it can be detected as a hot spot on a technetium bone scan, confirmed by a similar uptake in a white cell bone scan. MRI scan has emerged as the most sensitive and specific test for osteomyelitis and should be performed if the diagnosis is in doubt. If an ulcer is big or so deep that bone can be probed at the bottom of the ulcer, one should suspect that osteomyelitis is present.

What next?

If you notice any signs of infection in a foot ulcer, notify your doctor or podiatrist right away. You need to be seen at once before the infection spreads further. You may notice signs of infection even if you don't have an open sore or ulcer. If you notice any redness, swelling, or oozing around your toenail, for example, or at the site of a cut or splinter, you also need to call your doctor right away.

How to prevent?

Many patients are hesitant to take antibiotics and many doctors are hesitant to prescribe antibiotics. Nonetheless, when infection is present in the foot of a person with diabetes, antibiotic treatment is required and many feet are lost unnecessarily due to failure to treat the infection.

Make sure to keep any open sore clean and dry to prevent ulcers or other areas of the foot from becoming infected. The doctor may suggest treating any ulcer with antibiotic ointment or solution to prevent infection. Make sure you avoid walking or further irritating the ulcer. Keep a close eye on the wound for any further changes in its appearance. Keeping blood glucose levels as close to normal as possible might also help during the healing process.

How to treat?

The doctor will probably first culture material from the sight of infection and will probably treat with an antibiotic depending on what sort of organism is causing the infection. This could be an antibiotic or a fungal agent that can be taken orally, one that is applied topically, or both.

The doctor needs to conduct blood tests to check blood glucose level and white cell count, he might also examine by X ray to make sure there is no sign of bone infection. If the infection is not severe, you will be treated on an outpatient basis, but you should be seen every 2 or 3 days for the first week or so.

Most infections will show some improvement in a few days and if you have a soft-tissue infection, you will probably need to take antibiotics for 2 weeks. You may need antibiotic therapy for 6 weeks or longer if the infection has reached the bone. Make sure to take the prescribed antibiotics for the entire time, even if you think it is getting better.

Contact your healthcare provider if the infection gets worse even if you are scheduled for an appointment soon. Signs of a worsening infection include fever or rise in temperature, increased pain, redness, warmth, or pus formation.

Besides antibiotics, the doctor takes other steps to encourage the healing of infected ulcer. For an ulcer to heal, it has to be covered with a healthy layer of tissue, with no dead cells in the way, and for this, your doctor may perform a surgical debridement. In this process all dead tissue will be removed from the wound and this needs to be done frequently as the wound is healing. Do not attempt to do this yourself!

The doctor may give instructions for dressing the wound along with an antibiotic solution or ointment. After cleaning the site of infection, either apply the ointment directly or soak a piece of clean gauze in antibiotic solution and apply it to the wound. You will probably want to cover the wound with clean sterile gauze in between dressings.

Make sure not to walk on your infected foot. If you need to get around, consider using a pair of crutches or even a wheelchair. If you notice any swelling, keep your leg elevated.

While your infection is healing it is important to keep your blood glucose levels under control. Infection can upset your blood glucose levels, but too much glucose in the blood can impair healing and promote infection. Therefore, test your blood glucose levels frequently and treat hyperglycemia or hypoglycemia if necessary.