the diabetic foot - infection or foot ulcers

see also:

• cellulitis
• sepsis / septicaemia
• diabetes mellitus
• venous leg ulcers
• WH policy - diabetic foot infections (doc) - intranet only
  • At WH, these patients are generally referred to Diabetes Fooot Service, endocrinology and vascular surgery which are based at Footscray Hospital (NOT Sunshine Hospital)

• does the patient need urgent care for sepsis / septicaemia?
• patients with diabetes and foot infections should be assessed in terms of:
  • presence of infection (see cellulitis), and if so:
    • how severe is it?
    • is there underlying osteomyelitis?
      • high inflammatory markers such as erythrocyte sedimentation rate (ESR) > 70 or C reactive protein (CRP)
      • plain XR
      • +/- MRI scan or if C/I then WCC-labelled radionuclide nuclear med bone scan
    • systemically unwell patients should also be evaluated for potential surgical emergencies such as:
      • necrotizing fasciitis
      • gangrene
      • early surgical debridement of moderate or severe infections may reduce risk of lower limb amputation
      • deep foot abscesses
  • evidence of neuropathy (see peripheral neuropathy)
  • evidence of ischaemia (see peripheral vascular disease (PVD or PAD))

• if “severe” infection then:
  • commence as per sepsis / septicaemia with choice of antibiotic to target likely pathogens- see local policies
  • blood cultures, FBE, U&E, ESR, CRP, glucose
  • wound swab
  • XR
  • early referral to diabetic foot team for admission and surgical assessment
• if no clinical infection then:
  • swabs are NOT needed
  • FBE, U&E, ESR, CRP, glucose to assist in determining presence of occult infection
  • refer to diabetic foot clinic