Infection is a common and serious complication of diabetic foot wounds. Infection leads to formation of microthrombi, causing further ischemia, necrosis, and progressive gangrene.
Massive infection is the most common factor leading to amputation. Because infection in the diabetic foot can be complex, consultation with an expert in infectious disease may be beneficial.
Response to infection is often altered in the patient with diabetes. Infection-fighting capability is often diminished because of impaired leukocyte function. Impaired leukocyte function is significantly influenced by the degree of hyperglycemia; therefore, tight blood glucose control is extremely important when infection is present.
In addition, patients with diabetes and severe foot infection often do not respond to the infection with elevation of body temperature and/or white blood cell (WBC) count.
In addition, patients with diabetes and severe foot infection often do not respond to the infection with elevation of body temperature and/or white blood cell (WBC) count.
Leichter et al have reviewed laboratory data in a large series of diabetic patients with serious pedal infections. Despite significantly elevated sedimentation rates, the mean WBC count was 9,700/102/mm3.
Gibbons and Eliopoulos have also documented the absence of temperature elevation, chills, or leukocytosis in two thirds of the patients with limb-threatening infection, including abscesses and extensive soft tissue infection. Similarly, Eneroth et al[ found that approximately 50% of patients with foot infection had temperatures under 37.8°C and WBC counts under 10,000/102/mm3. Given these findings, the clinician should not depend on elevated WBC counts and/or temperature elevation alone as indications of the severity of a diabetic foot infection.
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2 comments:
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There are 2 issues with feet and diabetes. The first is that diabetes causes problems with small artery peripheral circulation. At low level this can cause problems with the skin of the feet so it is a good idea to moisturise them regularly. It is essential that diabetics never,ever,ever smoke, ( I was tempted to add more 'evers' but thought it might be over the top,) as this too damages peripheral circulation and in combination there is a much higher likelihood of more severe tissue damage. The feet are affected most as they are furthest,circulation wise from the heart. Again if the sugar in the tissues is high the healing of any damage may be slow as the circulation is poor.
The second problem is that diabetics can develop peripheral neuropathy. This is damage to the peripheral nerves as a result of the toxic effect of chronic high tissue sugars,it is minimised by good diabetic control
. This produces 2 potential issues,pain in the feet.This occurs because when nerves are damaged they lose the ability to convey the sensations of pressure,heat,touch etc and retain only the ability to produce pain no matter what stimulation is applied to the nerve endings. The second is they can become so damaged that they no longer function at all, producing numbness. This becomes a problem as for example,a tight fitting shoe may damage the foot,and this can become quite severe without being noticed.Then,because of the circulatory issues the tissue can become badly damaged and is then slow to heal.
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