Posts Tagged ‘Diabetic Foot Complications’

Urgent! Risks and Diagnosis of Diabetic Foot Infections

Friday, January 8th, 2016

For effective diabetic wound management, clinicians must know the risk factors for foot infections, and be able to diagnose them properly – and as soon as possible.

Diabetic Foot Infections

Wound care clinicians deal with foot infections all the time, but when the patient is also diabetic, an infection can progress rapidly to a critical state. In fact, it is estimated that around 56% of diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.  Being able to treat diabetic foot infections promptly – before they progress too far – helps prevent amputations, which is why your role is so crucial to a patient’s well-being.

What are the risk factors?

If you are treating a diabetic patient with a foot infection, there are a number of risk factors to consider. These include:

  • 30-day-old wounds
  • Wounds that go down to the bone
  • Recurrent foot infections
  • Peripheral vascular disease
  • An etiology from trauma

In particular, be on high alert with your diabetic patients for what they call an occult (hidden) infection. A diabetic foot ulcer could clearly have an infection, but fail to show any of the classic signs and symptoms that you traditionally look for, like erythema, heat, pain and purulence.

Because a diabetic patient’s immune system is compromised, you might be on the lookout for typical signs but not see any of them at all. This does not mean that an infection isn’t there; only half of diabetic foot ulcer patients will show classic signs, which means we also need to work our patients up for infection.

The best approach? Be persistent and keep looking for more signs, like:

Free Webinar - Diabetic Ulcers

  • Serous exudate (thin, clear, watery)
  • Delay in healing
  • Friable (fragile) granulation tissue
  • Discolored granulation
  • Odor
  • Pocketing in the wound bed

How do we diagnose infection?

Diagnosing infection in any wound, particularly with diabetic patients, is a clinical one (versus a lab diagnosis). So if you ever hear a colleague say, “We’re going to wait for the lab results to see if our patient has a wound infection,” it’s time to stand up and emphatically say, “No!” Why? Because lab results, specifically the swab cultures that are most commonly used, are often inconclusive in the presence of biofilm. Instead of waiting for the results, you need to act immediately.

That’s not to say that lab results aren’t useful. They can sometimes help us confirm infections and target which antibiotic we want to use. But again, most infections are polymicrobial (containing more than one kind of bacteria), and swab cultures don’t pick up everything. We need to use our clinical judgment and supplement with lab and cultures.

The Final Word

As wound care professionals, prevention is obviously our first line of defense against any wound complications from infections. But when caring for diabetic patients, clearly understanding the risk factors for foot infections, and then being able to diagnose conditions as soon as possible, are crucial for effective treatment.

What do you think?

Have you had experience in treating diabetic patients with foot infections? Have you been able to identify the infection in a timely manner? Is there a particular case that was exceptionally challenging or difficult? Please tell us about it, and leave your comments below.

What is Charcot foot?

Thursday, January 1st, 2015

What is Charcot Arthropathy? Charcot foot, as it is commonly referred to, is a chronic progressive disease of the bone and joints found in the feet and ankles of Charcot_Footour diabetic patients with peripheral neuropathy.

What leads to this Charcot foot? Having long standing diabetes for greater than 10 years is one contributing factor. Having autonomic neuropathy leads to abnormal bone formation and having sensory neuropathy causes the insensate foot, or foot without sensation and thus susceptible to trauma, this is another contributing factor. These bones in the affected foot collapse and fracture becoming malformed without any major trauma. One common malformation you see related to Charcot foot is the “rocker bottom” where there is a “bulge” on the bottom of the foot where the bones have collapsed.

Your patient with Charcot foot will present with a painless, warm, reddened and swollen foot. You may see dependent rubor, bounding pedal pulses, and feel or hear crackling of the bones when moving the foot. If a patient were to continue to bear weight on the Charcot foot there is a high chance for ulceration that could potentially lead to infection and/or amputation.offloading_devices

Continued, on-going weight-bearing can result in a permanently deformed foot that is more prone to ulceration and breakdown. Prompt treatment is necessary using total contact casting, where no weight bearing will occur on the affected foot for 8-12 weeks. Our job as wound care clinicians is good foot assessment with prompt identification and treatment of this acute Charcot foot to prevent foot deformity and further complications in the diabetic patient.

 

Diabetic Patient Education

Monday, December 29th, 2014

Patient education plays a vital role in positive outcomes for our diabetic patient. Diabetic patients need to understand the importance of proper foot care and importance of good blood glucose control to maintain the integrity of their feet.

So what do our patients need to know? They need to work closely with their physician and the dietician to be sure their blood glucose levels are properly controlled. foot_mirror_between_toesThe ADA recommends an A1c below 7%.  They need to know how important it is to check their feet daily to catch any problems early. We as clinicians need to teach them how to do this and what to look for. Teach your diabetic patients to inspect their feet everyday. They can do this by having family members or caregivers check their feet, or they can use a mirror and do it themselves.

Explain to your patients what exactly they are looking for; cuts, sores, red spots, swelling, infected toenails, blisters, calluses, cracks, excessive dryness or any other abnormality. They should check all surfaces of the feet and toes carefully, at the same time each and every day. Explain to your patients to call their physician right away if they notice any abnormalities or any open areas. Other problems the diabetic patient should be aware of with their feet and report to their physician include tingling or burning sensation, pain in the feet, cracks in the skin, a change in the shape of their foot, or lack of sensation – they might not feel warm, cold, or touch. The patient should be aware that any of the above could potentially lead to diabetic foot ulcers.

Instruct your patients to wash their feet every day, but not soak their feet. Use warm, NOT hot water – be sure they check the water temperature with a thermometer or shoe_fittheir elbow. Dry feet well, especially between toes. Apply lotion on the tops and bottoms of their feet but not between toes. Trim toenails each week and as needed after bath / shower, trim nails straight across with clippers, smooth edges with emery board.

Wear socks and shoes at all times, the diabetic patient should never be barefoot, even indoors. Have them check their shoes prior to wearing, be sure there are no objects inside and the lining is smooth.  Instruct them to wear shoes that protect their feet; athletic shoes or walking shoes that are leather are best, be sure they fit their feet appropriately and accommodate the foot width and any foot deformities.

For our diabetic patients, glucose control is a key factor in keeping them healthy, but patient education and understanding of proper foot inspection and what findings to report to their physician are just as important for the well being of our diabetic patient.

Free Webinar “How-To: Diabetic Foot Exam Made Easy”. Use Promo Code: DFOOT  through 12/31/15.

Diabetic Foot Complications: Time To Take The Shoes Off and Battle

Friday, June 17th, 2011

Diabetic Foot Complications

Diabetic Foot Complications: Time To Take The Shoes Off and Battle will be presented at this year’s Wild On Wounds National Convention in Las Vegas NV at Caesars Palace by David Yeager DPM, FASPS, FACFAS, KSB Foot and Ankle/ Wound Care Center

Diabetic foot complications are an everyday occurrence. Lets talk about what we are up against. Learn how to identify, treat, and prevent diabetic foot complications we are up against. Learn how to identify, treat and prevent diabetic foot complications. We will discuss the significant morbidity that is associated with these infections and the financial impact they have on the delivery of care.

This session will be held on Thursday September 8, 2011 from 2:15-3:15 p.m

For more Information about the Wound care Education Institute and WOW 2011, Check out Wild on Wounds National Convention