Diabetic Foot Infections

Diabetic foot infections are one of the most common complications that result from diabetes. The infection occurs in the soft tissue, the bone, muscles, or multiple locations and can lead to amputation if left untreated. Many times, infection results from open sores or ulcers on the feet that are vulnerable to bacteria. As a person with diabetes ages, their chances of developing a diabetic foot infection increase. 

Cuts and wounds are sometimes not easy to detect for people with diabetes due to a loss of feeling in the feet (neuropathy) and poor blood flow. However, quick detection and treatment of any cut or infections is crucial because early intervention is necessary to save the foot from future complications. A person’s risk of developing diabetic foot infections in their lifetime is around 15%, making the condition relatively common among people with diabetes.

What are diabetic foot infections?

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A diabetic foot infection is a common but serious injury experienced by people with diabetes. As with all infections, this condition occurs when bacteria enter the body, often through a wound. A diabetic foot infection can appear as the result of an otherwise small injury. These small scrapes, scuffs, and blisters, which most people experience without issue, can lead to diabetic foot ulcers. Diabetic ulcers are not infections, but they often lead to infections. These ulcers often exist without notice and can develop into serious wounds over time. Once the diabetic ulcer forms, pathogens can enter the blood stream and create an infection.

As with most infections, antibiotic treatment is necessary to cure a diabetic foot infection. If the wound is not treated by a medical professional, the infection can spread, leading to pain, discomfort, necrosis, and, in the worst cases, amputation. If you suspect you have a diabetic foot infection, schedule an appointment with your doctor. Fast and efficient treatment is necessary, and without medical attention, a diabetic foot infection can be life-threatening.

What causes a diabetic foot infection?

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Two main factors contribute to diabetic foot infections. The first is neuropathy, or nerve damage, that can significantly impair feeling in the legs and feet. The inability to feel pain means that people at risk for developing an infection may not feel a blister developing inside a sock, or possibly a pebble that has worked its way into a shoe. The person might not know to remove the source of friction or injury, which can lead to a laceration. This vulnerability allows potentially harmful bacteria to enter the body unnoticed.

Peripheral artery disease is another phenomenon that can cause diabetic foot infection. People with this condition have impaired blood flow, which can slow or prevent the healing of a small injury. This, in combination with not being able to feel the initial injury, can put diabetics at risk of developing moderate to severe foot infections.

Research also shows that heightened blood glucose, such as that experienced by diabetics, can impair white blood cells’ ability to navigate to an infection, expediting the infection’s development. Additionally, dry skin is a common experience for people with diabetes, which means foot skin can crack and create entry points for bacteria.

What are risk factors for diabetic foot infection development?

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Around 25 percent of people with diabetes will develop significant foot problems. If you have been diagnosed with diabetes, there is a high chance that you will experience a foot infection. However, there are additional activities that may put you at a higher risk of infection.

  • Spending time in cold, wet weather. This can increase foot numbness and skin dryness, both of which can add to the risk of infection.
  • Soaking feet. Diabetics should not soak their feet, especially in Epsom bath salts, as this can increase the risk of infection.
  • Not wearing socks, which can increase the likelihood of sustaining an injury.
  • Wearing uncomfortable shoes, which can cause blisters.
  • Not washing the feet regularly or thoroughly.
  • Consuming alcohol.
  • Tobacco use, which inhibits blood circulation.
  • Neglecting to trim or improperly trimming toenails, which can cause lacerations.

Diabetic foot infections are also more common in people who have heart disease, kidney disease, and eye disease (from diabetes). Older men are more likely to have diabetic foot infections, as well as those who are obese.

What are the symptoms of diabetic foot infection?

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The symptoms of diabetic foot infections are similar to those of any infection. The area around the injury will become red, eventually spreading from the original site. People with diabetic foot infections will also experience pain or tenderness at the site of the wound, and the original cut may seep pus.

Once the infection has developed, a person will begin to experience non-local symptoms. This can include any of the following.

  • Fever
  • Chills and sweats
  • Shortness of breath
  • Nasal congestion
  • Stiff neck
  • A new mouth sore

People with diabetic foot infections may also notice black tissue, called eschar, surrounding the diabetic ulcer. This forms in the absence of healthy blood flow to the area. Partial or complete gangrene can also appear around the ulcer, creating discharge, pain, and additional numbness.

It is important to remember that most people don’t notice an issue until the initial injury becomes infected. If you are experiencing signs of an infection, whether in your feet or another part of the body, seek medical attention as soon as possible. Only a doctor’s prescription can provide access to necessary treatments.

How is a diabetic foot infection diagnosed?

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A doctor should be able to provide a diabetic foot infection diagnosis. During your appointment, you should expect the doctor to complete a thorough physical examination. They will look for local signs of an infection, like swelling and discharge, as well as systemic signs, like a fever. The doctor will remove any existing necrotic tissue and clean the wound, and they may take a sample to determine the severity of the infection. This tissue sample will be sent to a lab to determine which antibiotic treatment will best help. If the doctor suspects your diabetic foot infection is serious, they may order an X-ray and look for signs of bone infection.

While the signs of infection may sound easily recognizable, only a doctor has the experience and education necessary to provide an accurate diagnosis. If you think you may have a foot infection or other type of injury, schedule an appointment as soon as possible. Seeing a doctor earlier in the process can reduce the risk of developing irreversible health issues.

What is the best treatment for a diabetic foot infection?

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Prior to prescribing treatment, the doctor will first clean the wound and surrounding area. They will remove the diabetic foot ulcer, dead skin, and any potential foreign objects. They may also dress the wound with topical treatments, like silver or sulfadiazine cream, polyhexamethylene biguanide (PHMB) gel, and iodine.

Like most infections, diabetic foot infections respond best to antibiotic treatment. However, you may also be prescribed antiplatelets and/or anti-clotting medications if the infection progresses. Visiting a doctor is the only way to secure these diabetic foot infection treatments.

While undergoing an antibiotic regimen, your doctor may also recommend wearing diabetic shoes, getting a cast, using compression wraps, and using shoe inserts, which are designed to prevent corns and calluses.

A doctor may also recommend a patient undergo surgery to treat and prevent diabetic ulcers. Foot surgery may be used to alleviate pressure by shaving down the bone or removing foot deformities, which can cause ulcers. In the most severe cases, amputation may be necessary to remove gangrenous skin and stop the spread of infection to other parts of the body.

How do you prevent a diabetic foot infection?

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According to podiatrists like our own Dr. Robert C. Parajon, the best way to prevent a diabetic foot infection is to complete regular inspections. Check your feet regularly. It can help to build this foot check into a daily routine, such as directly after brushing your teeth in the evening. To conduct an inspection, take off your shoes and socks and use a mirror to examine all parts of the feet. Check for redness around the nail beds, potential calluses, blisters, and cracks in the feet. If you find any injuries that don’t appear to be infected, treat them at home by cleaning the wound, bandaging the area, and checking the injury frequently until it heals.

Additionally, it is important to wear comfortable shoes, wash your feet regularly, and use moisturizers to prevent the skin from cracking. Cut your nails frequently, avoid extreme temperatures, and address calluses whenever possible. Refrain from walking barefoot and wearing tight stockings, as this can increase your risk of injury.

If you find anything wrong with your feet that does not disappear with at-home treatment, schedule a visit with your physician or podiatrist as soon as possible. The faster a foot infection is addressed, the faster and more quickly it will heal.

Should you see a doctor for diabetic foot infections?

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As soon as you notice symptoms of an injury on your foot or an infection, you should see your healthcare provider. Proactive foot care is essential for people with diabetes to try to prevent infection or treat the infection in its earliest stages. You should contact your primary care physician and inform them of any changes to your foot or any concerns you may have about potential infection. 

Communicate anytime you notice pain or tingling in your feet, thickened and yellowed toenails, a loss of feeling in the feet, or changes in the skin of the foot, including a loss of hair, redness, or a funny smell. 

What are the complications of diabetic foot infections?

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There are a number of complications of diabetic foot infections. The most frequent complications that result from an infection are the following: 

  • Sepsis: A diabetic foot infection can cause the body to go into shock and develop sepsis, requiring emergency medical attention. 
  • Bone fracture: Diabetes can weaken your bones and make an undetected bone fracture more likely. Nerve damage can make it hard to tell if your foot is injured, making the bone not heal properly absent medical attention. 
  • Osteomyelitis: Osteomyelitis occurs when an infection of the soft tissue of the foot spreads to the bones in the foot. An infection that spreads to the bone can make a person more likely to have to get the foot amputated. 
  • Gangrene: Gangrene can result if blood flow remains restricted to the foot and the tissue in the foot dies. 
  • Amputation: If a foot infection is not treated in time, the infection can spread, resulting in the need to amputate the foot to stop the infection from reaching other parts of the body. 

What is the outlook for people living with diabetic foot infections?

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The outlook for people who have had a diabetic foot infection depends on the severity of the infection and a person’s health history and lifestyle. If a wound was found early, treated effectively, and the person takes measures to protect their feet and manage their glucose levels, that person may enjoy a better outlook. However, people with diabetic foot infections generally cannot fully recover or restore feeling back to their feet. 

A serious diabetic foot infection complicates a person’s outlook. A bad infection could require a person to amputate their foot. Amputations then create a difficult outlook since the procedure can lead to other cardiac event risks. In addition, infections can return and complicate a person’s life significantly. Taking precautions with your foot care is essential to a person’s outlook with a diabetic foot infection. 

How do you take care of your feet when you have diabetes?

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You can incorporate the following best practices for diabetic foot care to stay on top of infections and avoid injury. 

  1. Manage your blood sugar levels to avoid hyperglycemia. 
  2. Check your feet each day for injuries and contact your doctor if you notice anything on your feet. 
  3. Have your feet checked during every healthcare visit and have your doctor trim your toenails if you have nerve damage in your feet. 
  4. Keep your feet covered with socks and well-fitting shoes all the time to prevent injury.
  5. Keep your feet dry, clean, and warm. 
  6. Avoid smoking. 
  7. Encourage good circulation by elevating the feet when resting and choosing low impact activities to improve blood flow.