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Diabetic Foot Infection

Sydney Vascular Surgeon - Dr Mayo Theivendran

What is a diabetic foot infection?

Diabetes is a common cause of chronic foot infection. If you have diabetes and you develop a sore on your foot or lower leg, it can often be difficult to get it to heal properly.

Left untreated, diabetic foot infection can spread and sometimes the affected limb is lost.

Diabetic foot infections affect 19-34% of the estimated 537 million people worldwide with diabetes.

Women who have had children are more likely to have pelvic congestion syndrome than those who have not had children

What are other causes of chronic wounds?

Trauma, peripheral arterial disease, or compromised immunity can also result in chronic wounds which can affect both the soft tissue and/or bones.

How does diabetes increase the risk of foot sores?

Diabetes increases your risk of foot sores in a number of ways:

Diabetes causes nerve damage that increases the risk of foot sores

Nerve damage (neuropathy)

High blood sugar levels can damage nerves over time. This can result in a loss of sensation in the feet, making it difficult to notice injuries or pressure points that could lead to ulcers.

Diabetes causes poor circulation  that increases the risk of foot sores

Poor circulation

Diabetes can lead to reduced blood flow to the extremities, including the feet. This decreased circulation can make it harder for your body to heal wounds.

People with diabetes are at higher risk of developing pressure points which in turn, increases the risk of foot sores

Pressure points

Constant pressure and friction on certain areas of your feet, often from ill-fitting shoes, can cause calluses or sores that may develop into ulcers. You may not realise this is happening at first, because of the lack of sensation in your feet.

Diabetes causes a weakened immune system that increases the risk of foot sores

A weakened immune system

Once an ulcerated sore forms, it can become infected. Diabetes weakens your immune system's ability to fight off infections, making healing even more challenging.

What are the of symptoms of diabetic foot infection and chronic wounds?

The symptoms of diabetic foot ulcers and chronic wounds can vary, but here are some common signs to watch for:

Open sores are a symptom of diabetic foot infection

Open sores

You might notice a sore or wound on your foot or another part of your body that doesn't seem to be healing.

Redness and swelling are  symptoms of diabetic foot infection

Redness and swelling

The skin around the ulcer may become red, warm to the touch, or swollen.

Drainage, pus and odour are  symptoms of diabetic foot infection

Drainage, pus and odour

An ulcer might ooze fluid or pus. A foul smell may be present, indicating an infection.

Illustration of a healthy foot compared to a diabetic foot with ulcers

How are foot ulcers and chronic wounds diagnosed?

If you suspect you have a foot ulcer or a chronic wound, it's essential to see a healthcare provider. They will usually perform the following steps to diagnose and assess the condition:

Physical examination is helpful in the diagnosis of diabetic foot infections

Physical examination

Your healthcare provider will examine the wound, looking for signs of infection and assessing its size and depth.

Blood tests are used in the diagnosis of diabetic foot infections

Blood tests

Blood tests can reveal your blood sugar levels, as well as any signs of infection.

Imaging is used in the diagnosis of diabetic foot infections

Imaging

In some cases, imaging tests like X-rays or MRIs may be used to check for any underlying bone or tissue damage.

What are the treatments for diabetic foot ulcers and chronic wounds?

The treatment of diabetic foot ulcers and chronic wounds is focused on three main goals:

  • Controlling infection
  • Promoting healing
  • Preventing recurrence.
Your treatment plan will depend on the severity of the wound and its underlying causes. Here are some common approaches:

Women who have had children are more likely to have pelvic congestion syndrome than those who have not had children

Dysvascular Foot Breakdown

Diabetes causes nerve damage that increases the risk of foot sores

Wound care

If you have an ulcerated sore on your foot, keeping the wound clean and properly dressed is essential. Your doctor may recommend specialised dressings or topical treatments to support healing.

Diabetes causes nerve damage that increases the risk of foot sores

Offloading

Offloading means reducing pressure on the affected area, with the help of special footwear, casts, or orthotic devices to take the pressure off the wound.

Diabetes causes nerve damage that increases the risk of foot sores

Infection control

If an infection is present, antibiotics or other medications may be prescribed by your treating doctor.

Diabetes causes nerve damage that increases the risk of foot sores

Blood glucose management

If you have diabetes, keeping your blood sugar levels within a healthy range is crucial to support healing.

Diabetes causes nerve damage that increases the risk of foot sores

Debridement

Your doctor may need to remove (debride) dead or infected tissue to facilitate healing.

Diabetes causes nerve damage that increases the risk of foot sores

Hyperbaric oxygen therapy

This therapy involves having you breathe pure oxygen in a pressurised chamber to promote wound healing.

Diabetes causes nerve damage that increases the risk of foot sores

Skin grafts, tissue flaps and amputation

Healthy skin from another part of your body or a donor source can be transplanted to cover the wound. In a tissue flap procedure, nearby healthy tissue is moved to cover the wound, aiding in the healing process. As a last resort, if the infection is severe and cannot be controlled, amputation of the limb may be required to prevent it from spreading further.

Surgical revascularisation procedures

For a wound to heal properly, it needs a good supply of blood. In the case of chronic foot ulcers, impaired blood flow to the lower legs is a barrier to healing. Without proper blood flow, your body's natural healing mechanisms are compromised, and the ulcer can persist or worsen.

Surgical revascularisation is a procedure designed to enhance blood flow to the area with the chronic ulcer.

How is surgical revascularisation performed?

There are different methods of surgical revascularisation, and the choice of technique depends on your specific condition and the underlying causes of the reduced blood flow.

Common techniques include:

  • Angioplasty: A sophisticated and minimally invasive vascular procedure, is instrumental in addressing narrowed or blocked blood vessels in the lower extremities, particularly crucial for patients with diabetic foot infections where impaired blood flow impedes healing.

    An angioplasty involves inserting a catheter with a balloon at its tip into the affected blood vessel. After careful insertion and guidewire placement, the balloon is inflated, exerting controlled pressure on vessel walls to compress plaque and widen the vessel lumen, thereby restoring normal blood flow.

  • Stent placement: Often combined with angioplasty, a stent is a small, mesh-like tube that is placed in the blood vessel to keep it open, preventing it from narrowing again.

Angioplasty is used as a surgical revascularisation for diabetic and chronic wounds

  • Bypass surgery: Bypass surgery, a critical intervention for patients facing blocked or narrowed blood vessels, entails the creation of a new path for blood flow.

    Bypass surgery involves using a graft, typically a healthy blood vessel sourced from another part of the body. The graft is meticulously positioned to bypass the obstructed area, allowing blood to flow freely.

Stent placement often combined with angioplasty is used as a surgical revascularisation for diabetic and chronic wounds

  • Endarterectomy: An endarterectomy involves the meticulous removal of the inner lining of a blocked artery to enhance blood flow. This intervention is particularly significant for individuals facing arterial blockages, a condition common in patients with diabetic foot
    infections.

    During the procedure, Dr Theivendran skilfully excises the obstructing material, promoting the restoration of optimal blood circulation.

Stent placement often combined with angioplasty is used as a surgical revascularisation for diabetic and chronic wounds

Benefits of surgical revascularisation

Surgical revascularisation can improve blood flow, relieve pain and help poorly vascularised wounds to heal.

Read more about endovascular surgery

Read more about open vascular surgery

  How Dr Theivendran can help

If chronic foot infection is affecting your quality of life and the treatments haven’t worked, ask your treating doctor for a referral to Dr Theivendran, an experienced Vascular and Endovascular surgeon.

He will assess your condition and, if appropriate, discuss surgical options that can help improve blood flow to the affected area.

If you have any questions, please don't hesitate to contact our rooms on (02) 9066 6547

For appointments and enquiries:

Monday - Friday: 8:00am to 5:00pm
Fax: (02) 9182 7533

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