What is an infection?

An infection occurs when germs multiply and cause damage to tissue. Bacteria cause infections. In order for a foot infection to develop there has to be an opening for the germs or bacteria to get into the foot. In other words there needs to be a break in the skin or an ulcer or a wound. Not all wounds will get infected, but the longer a wound remains non-healed the greater the chance of developing an infection. People with diabetes are more prone to developing wound infections especially those with poor blood sugar control.

Foot infections can have serious consequences especially if they are not recognized and treated in a timely manner. Infection can cause serious injury to the affected part and thus needs to be treated as early as possible. Sometimes antibiotics and wound care is all that are necessary for treatment. In more serious or advanced infections surgery may also be necessary.

What are the signs and symptoms of a Foot Infection?

There are changes and signs that happen with infection. In early case of infection the changes will mostly be in the foot. As the infection spreads and worsens, changes may also occur throughout the body. Persons with diabetes should check their feet daily. Warning signs of a foot infection include swelling, redness, increased warmth and, in some but not all instances, pain. Odor can also be a sign of foot infection. Infections do not usually occur without a break in the skin such as a cut or a foot ulcer (sore). If there are signs of infection without a break in the skin then other conditions need to be considered.

How should I check my feet for signs of an Infection?

Persons with diabetes should check their feet daily for signs of infection. Compare the feet to see if one is redder, swollen or warmer. The best way to compare temperature of the feet is to run the back of one’s hands over the feet to feel for temperature differences. Increased temperature by itself is an indication of inflammation which could be due to infection or it could be due to other things like over activity or injury. Pain may not always be present especially in those with neuropathy or feeling loss. Persons who suspect an infection should visit their health care provider as soon as possible.

Infection can spread from the feet to the rest of the body. Signs of spreading infection swelling, redness and warmth spreading into the leg, fever, chills, nausea, vomiting, sudden changes in blood sugar, feeling tired or not well and loss of appetite. If these signs are occurring then emergency treatment of the infection is necessary.

What can I do to prevent a foot infection?

Persons with diabetes can decrease the risk for foot infection by adhering to good diabetic foot care, blood sugar control and daily foot inspection. Infections are serious problems that could result in leg or life loss and therefore require prompt attention. Daily foot inspections are even more important if there is an open wound or sore. If there is a dressing on the wound then the daily inspections can still be done by feeling around the dressing and feeling the leg. The dressing should be inspected to make sure that drainage is not coming through the dressing.

If there are concerns about infection then don't be worried about "bothering your health care provider unnecessarily.” Diabetic foot infections require prompt and assertive treatment and the sooner that treatment is started the better the chance for a good outcome.

How are infections treated?

By far the best method to treat an infection is to prevent from happening in the first place. However, an infection can be treated through the use of antibiotics. Some antibiotics actually kill the germs; whereas, others slow down the growth of the germs. There are many different types of germs that can cause infection. There are also many different types of antibiotics. Sometimes more than one type of germ is involved in the infection; therefore, sometimes several different antibiotics are required to fight the infection.

One of the ways to select an antibiotic is to take a culture of the infection. Cultures are typically done by swabbing an area of the infection with a sterile cotton tip applicator that is like a Q-tip. The culture is sent to a lab for identification. The lab also tests to see which antibiotics will be affective against the germs. Culture swabs are a way of identifying the germs in an infection. All wounds have germs but not all wounds are infected. Wounds are only infected if the germs are growing and causing injury to the tissue. Culture swabs can identify the germs but they cannot diagnose infection. The diagnosis of infection is dependent on different factors and signs.

Antibiotics can be given as pills or by intravenous. Some antibiotics can be applied as creams or ointments directly onto the wound. The method of administration is dependent on several factors including location of the infection, severity of the infection and type of germ.

Many persons with diabetes will be familiar with the term MRSA (methicillin resistant staphylococcous aureus). Germs can develop resistance to antibiotics, as in the case of MRSA... Fortunately there is still an antibiotic that will treat MRSA (vancomycin). But it is very important not to over use antibiotics. Please make sure that you fully understand the directions on your prescription. If you have any questions, you should consult your physician or pharmacist.

Timothy P. Kalla, D.P.M., F.A.C.F.A.S.