Professional Documents
Culture Documents
Epidemiology
Cellulitis occurs 9 times more
frequently in diabetics than nondiabetics
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
Epidemiology
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
Epidemiology
(of amputation)
Pathophysiology
Metabolic derangement
Faulty wound healing
Neuropathy
Angiopathy
Mechanical stress
Patient and provider neglect
Sensory Neuropathy
Unaware of a foreign body
Pressure in shoes
Abrasions in shoes
Tears or brakes in the skin
Motor Neuropathy
Architectural deformities
Hammer or claw toe
High plantar arch
Subluxation of metatarsals
Autonomic Neuropathy
Anhidrosis
Dry, cracked skin
Angiopathy
Can play a primary role
Microangiopathy +/-
Foot Anatomy
Compartments, low amount of soft tissue,
tendon sheaths
Deep plantar space
Medial, central and lateral
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
Evaluation
Describe lesion and signs of inflammation
Measure wound (? Photograph ?)
Define whether infection is present and cause
Examine soft tissue for crepitus, sinus tract,
abscess
Determine inflow
Neurologic status? Sensation, motor,
autonomic
Plain radiographs osteomyelitis (cortical
erosions, periosteal reaction)
Surgical Intervention
Surgical
Salvage the foot but not at the expense of
the leg or the patient
Early surgical debridement decreases LOS,
improves foot salvage and decreases
morbidity and mortality
Debridement
Remove all necrotic tissue and pus including eschar
Remove all callus
Debride bone
Treatment
Plantar abscess
Foot edema
Central plantar infections worse
outcomes
Wide incision and drainage necessary
Treatment
Empiric antibiotic therapy
Staph
Strep
GNR
Enterococcus
Anaerobes
*Tailor to clinical progress
Antibiotic thoughts
Mild (po) Augmentin/Levofloxacin
(+Clinda)
Bactrim/Flagyl
Antibiotic thoughts
Duration of therapy
No good studies
Once active infection resolved plus 2
days
Osteomyelitis
6 weeks
Can use Flouroquinolones and clindamycin
Prevention
THANK YOU