A diabetic foot and “diabetic foot infections” – DFI’s are any pathology that results directly from peripheral arterial disease (PAD) and/or sensory neuropathy affecting the feet in diabetes mellitus; it is a long-term (or “chronic”) complication of diabetes mellitus. Presence of several characteristic diabetic foot pathologies such as infection, diabetic foot ulcer and neuropathic osteoarthropathy is called diabetic foot syndrome.
Due to advanced peripheral nerve dysfunction associated with diabetes (diabetic neuropathy), patients’ feet have a reduced ability to feel pain. This means that minor injuries may remain undiscovered for a long while, and hence may progress to a full-thickness diabetic foot ulcer. The feet’s inability to pain, or being numb, can easily be established by 512 mN quantitative pinprick stimulation. Research estimates that the lifetime incidence of foot ulcers within the diabetic community is around 15% and may become as high as 25%. This is why extra prevention measures must be taken to prevent injury to the foot – many major issues often begin with a small blister and can become a severe infection in a short period of time – proper foot support via custom fitted orthotics is key to prevention.
In diabetes, peripheral nerve dysfunction can be combined with peripheral artery disease (PAD) causing poor blood circulation to the extremities (diabetic angiopathy). Around half of the patients with a diabetic foot ulcer have co-existing PAD. Vitamin D deficiency has been recently found to be associated with diabetic foot infections and increased risk of amputations and deaths.
Where wounds take a long time to heal, infection may set in, spreading to bones and joints, and lower limb amputation may be necessary. Foot infection is the most common cause of non-traumatic amputation in people with diabetes.
Prevention of diabetic foot may include optimizing metabolic control via the regulation of blood glucose levels; identification and screening of people at high risk for diabetic foot ulceration, especially those with advanced painless neuropathy; and patient education in order to promote foot self-examination and foot care knowledge. Patients would be taught routinely to inspect their feet for hyperkeratosis, fungal infection, skin lesions and foot deformities. Control of footwear is also important as repeated trauma from tight shoes can be a triggering factor, especially where peripheral neuropathy is present. Evidence is limited that low-quality patient education courses have a long-term preventative impact. A recent work critically evaluated the existing foot screening guidelines, with a view to examining their completeness in terms of advancement in clinical practice, improvements in technology, and changes in socio-cultural structure. This work clearly highlighted that limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.
When a person is dealing with diabetic neuropathy, preventing injury to the foot or toes is critical to maintain the health of your feet and mobility.
According to a 2011 meta-analysis, “Of all methods proposed to prevent diabetic foot ulcers, only foot temperature-guided avoidance therapy was found beneficial in RCTs”.
Treatment of diabetic foot ulceration can be challenging and prolonged; it may include orthopaedic appliances, surgery and antimicrobial drugs and topical dressings.
Most diabetic foot infections (DFIs) require treatment with systemic antibiotics. The choice of the initial antibiotic treatment depends on several factors such as the severity of the infection, whether the patient has received another antibiotic treatment for it, and whether the infection has been caused by a micro-organism that is known to be resistant to usual antibiotics (e.g. MRSA). The objective of antibiotic therapy is to stop the infection and ensure it does not spread.
It is unclear whether any particular antibiotic is better than any other for curing infection or avoiding amputation. One trial suggested that ertapenem with or without vancomycin is more effective than tigecycline for resolving DFIs. It is also generally unclear whether different antibiotics are associated with more or fewer adverse effects.
It is recommended however that the antibiotics used for treatment of diabetic foot ulcers should be used after deep tissue culture of the wound. Tissue culture and not pus swab culture should be done. Antibiotics should be used at correct doses in order to prevent the emergence of drug resistance. It is unclear if local antibiotics improve outcomes after surgery.
Best Feet professionally fit orthotic shoe arch supports provide immediate pain relief related to this condition. Proper support means less chance of injuring your foot or getting open wounds on your feet. Our pain relief experts are here for you with a free evaluation and balance test with no obligation. Don’t live in pain, book online, call or just walk in for same-day relief!
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