FOOT INFECTIONS IN PATIENTS WITH DIABETES

The combination of sensory neuropathy, ischemia and direct adverse eff ect on host defense mechanisms makes patients with diabetes vulnerable to foot infections. A high degree of clinical suspicion and vigilance is necessary for early diagnosis of soft tissue infections and their differentiation from noninfected ulcers. Diagnosis and assessment depe nd primarily on clinical history and physical examination, although ra diographs, scans and laboratory tests may also provide useful clinical data. The ability to detect bone in the base of an ulcer with a blunt sterile probe may be particularly useful in assisting the recognition of osteomyelitis. Most non-limb-threatening infections are caused by Gram-positive cocci, but more serious infections are often polymicrobi al. Effective treatment is based on a comprehensive strategy of wound care, avoidance of weight bearing, optimal metabolic control, appropri ate antibiotic use and, possibly, surgical intervention.