All foot infections in the diabetic patient need to be taken seriously. Patients need to be instructed to wash, dry and examine their feet daily and are encouraged to seek medical attention promptly if they see signs of foot infection or new ulcer formation. Osteomyelitis or plantar space infection should be excluded as complicating factors if there is not rapid clinical improvement after starting antibiotic therapy.Many people with long-standing diabetes mellitus are predisposed to foot injury, ulceration and infection because they have poor glycaemic control, peripheral vascular disease and/or peripheral neuropathy. If a wound has gone unnoticed or heals slowly, th… Download the IWGDF Guideline on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes below, and read about the […] Read more Infection guideline 02 Sep 2020 other possible diagnoses, such as pressure sores, gout or non-infected ulcersany symptoms or signs suggesting a more serious illness or condition, such as limb ischaemia, osteomyelitis, necrotising fasciitis or sepsisTo find out why the committee made the 2019 recommendations on reassessment of people with diabetic foot infection and how they might affect practice, see To find out why the committee made the 2019 recommendation on antibiotics to prevent of diabetic foot infection and how they might affect practice, see Diabetic foot infection is defined by the presence of at least 2 of the following:Local infection involving only the skin and subcutaneous tissue; if erythema, must be 0.5 cm to less than 2 cm around the ulcer (exclude other causes of inflammatory response, such as trauma, gout, acute Charcot neuro-osteoarthropathy, fracture, thrombosis and venous stasis).Local infection with erythema more than 2 cm around the ulcer or involving structures deeper than skin and subcutaneous tissues (such as abscess, osteomyelitis, septic arthritis or fasciitis), and no systemic inflammatory response signs.Local infection with signs of systemic inflammatory response (such as temperature of more than 38°C or less than 36°C, increased heart rate or increased respiratory rate).
Yet, providing care for people with diabetic foot disease remains crucial: as clinicians caring for these patients, we can play our role in the Corona-crisis, by doing everything we can to keep our patients with diabetic foot disease free from hospital. If left untreated, diabetic ulcers can lead to amputation. Small surface lesions may conceal significant deeper pathology requiring surgical intervention or aggressive antibiotic therapy. A thorough clinical examination with a positive Buerger's test suggests that ischaemia, not infection, is likely to predominate. Avoid a cast if the patient has significant peripheral vascular disease.If pre-existing peripheral vascular disease is likely to hinder the healing process a vascular surgeon should assess the patient's suitability for a bypass or stenting procedure.
The major p…