Foot Infection in

Diabetic Patients
Ali SABBOUR
How do diabetic foot ulcers
develop?
Several factors are involved

Peripheral neuropathy

Structural deformity

Infection

peripheral arterial disease

All of them are important, but one or more of them may predominate
 The basis of a successful
management of foot ulcers in
diabetics is to differentiate between
two main syndromes:

1)The neuropathic foot

2) The ischaemic foot
 The Neuropathic Foot
Sever peripheral neuritis, but pedal
pulses are intact.
Ulcers develop at the
sites of high mechanical
pressure
Usually related to
callus over the planter
surface of metatarsal
heads.
 The Neuropathic Foot

Ulcers are generally deep and painless

 The Ischaemic Foot
Ulcers develop in Pedal pulses
relation to minor are absent.
trauma or poorly
fitting shoes (foot
margins)
Ulcers are
generally
superficial and
For proper management of diabetic patients with foot ulcers, you should know:

Why are diabetic patients

more prone to develop foot
ulcers?
1) Neuropathy
2) Infection
3) Ischaemia
 Neuropathy
Neuropathy renders the foot more susceptible to
trauma by impairing:
• With repetitive stress on insensitive feet, helped
by deformity “hot spots” develop and callus
build up.

• Callus increases
foot pressure by as
much as 30%
 Neuropathy
• Inability to sense pain will block the
natural reflexes that would prevent injury.
• With repetitive stress
on insensitive feet,
helped by deformity
“hot spots” develop
and callus build up.
 Neuropathy

Deformity
Neuropathic affection of the
intrinsic foot muscles leads to
different deformities.
 Why are diabetic patients more prone to develop foot ulcers?

2) Infection
Once the ulcer has developed, the foot
is at risk of local infection

Diabetics have impaired immune

system: • Leukocyte transformation
• Chemotaxis
• Phagocytosis
 Infection
should be
diagnosed early
and treated
aggressively
2. Control of infection

• Diabetic foot infection is polymicrobial.

polymicrobial
• For guidance, cultures should be obtained
deep from the wounds. Cultures from
deep
superficial swabs are unreliable.
• The presence of gas
gas in plan X ray film
indicates severe anaerobic infection
 2. Control of infection

To cover the polymicrobial spectrum,

antibiotic combination is usually needed

• Aminoglycoside + Clindamycin
• Florinated Quinolones +
Clindamycin

For severe infections:

• Imipenam
3. Drainage and debridment
Establish the
actual size and
depth.
What appears to be
a superficial ulcer
may penetrate and
extend deep into
the tissues
 3. Drainage and debridment
• Infection may
spread from
apparently
superficial
alongalong
ulcers the
the planter
planter
tendons
tendons
to form a deep
abscess in the • The clinical picture does not
sole. match the extent of infection.
 3. Drainage and debridment

With good vascularity,

debridment should be
aggressive
aggressive , with removal
of all necrotic material
down to healthy bleeding
tissues.
 Osteomyelitis
The most cost-effective
method of treating foot
osteomyelitis is surgical
removal of all infected bone,
in conjunction with antibiotics.
 Why are diabetic patients more prone to develop foot ulcers?

3) Ischaemia

Diabetics are more prone

to develop atherosclerosis
 Patterns of
macrovascular
affection in
diabetics
Although diabetics
may suffer from SFA
& pop. occlusions,
 Patterns of macrovascular affection in diabetics

The characteristic
arterial affection
involves the popiteal
& tibial arteries.
Clinically, diabetics
are more likely to
have palpable pop.
pulse, with absent
pedal pulses.
 Diabetic patients with foot infection & ischemia (absent pedal
pulses) should correct ischemia first, then drainage and
debridment is done

Foot infection in Foot infection in

diabetic patient diabetic patient
with pulse without pulse

Correct ischemia
 Drainag
Then first:
 Debridment  Balloon angioplasty
 & antibiotics  Arterial bypass