Diabetic foot infections. Pathophysiology and treatment

Foot infections are among the most common reasons for hospital admission of the diabetic patient. A diabetic foot infection represents a failure by the patient and his management team to understand and correct the multifactorial conditions that predisposed the patient to the infection. Efforts directed toward prevention of the foot infection are much more likely to meet with success than is therapy of the established foot infection. This preventive approach is likely to lead to a reduction in the incidence of major amputations and thereby improve life expectancy. Understanding the pathophysiology associated with the diabetic foot is essential to the care of the diabetic patient. If a breach in skin integrity occurs, prompt assessment of vascular, neural, soft tissue, and wound status enhances the possibility of a successful clinical outcome. The complexity of the management of a diabetic requires the knowledge and skill of a multidisciplinary team, which usually includes an internist, podiatrist, rehabilitation specialist, prosthetist, dietitian, and social worker in addition to a surgeon interested in caring for the complications of diabetic feet. The goals of this multispecialty group are to optimize local wound care, provide correct foot wear, improve glucose control, educate the patient concerning diet and life style changes, and identify the presence of peripheral neuropathies and reconstructable arterial lesions. This combined medical team approach has been documented to substantially reduce the incidence of major and minor amputations in the diabetic.