Diabetic Foot Infections

Posted by e-Medical PPT
Epidemiology
Cellulitis occurs 9 times more frequently in diabetics than non-diabetics
Osteomyelitis of the foot 12 times more frequently in diabetics than non-diabetics
Foot ulcerations and infections are the most common reason for a diabetic to  be admitted to the hospital
25 % of diabetics will develop a foot ulcer
40-80% of these ulcers will become infected
25 % of these will become deep
50 % of patients with cellulitis will have another episode within 2 years
10-30 % of patients with a diabetic foot ulcer will go on to amputation

Pathophysiology
  • Metabolic derangement
  • Faulty wound healing
  • Neuropathy
  • Angiopathy
  • Mechanical stress
  • Patient and provider neglect

Poor Wound Healing
Poor granuloma formation
Prolonged persistence of abscess
Higher rate of carriage of Staph Aureus in the nares
Bullae, necrobiosis
Nail fungi (Tenia)

Poor Immune Function
Poor PMN functions
Migration, phagocytosis, intracellular killing, chemotaxis
Ketosis impairs leukocyte function
Monocyte mediated immune function diminished
Hyperglycemia impairs complement fixation

Motor Neuropathy
Architectural deformities
 Hammer or claw toe
 High plantar arch
 Subluxation of metatarsals

Diagnosis
Clinical presentation
 Presence of purulence
 Pain, swelling, ulceration, sinus tract formation, crepitation
 Systemic infection (fever, rigors, vomitting, tachycardia, change in mental status, malaise)
 Surprisingly uncommon
 Metabolic disorder (hyperglycemia, ketosis, azotemia)
 Should be considered even when local signs are less severe

Share Medical Presentations