Diabetic foot infections represent a major foot complication for patients with diabetes mellitus, necessitating the implementation of efficient foot care practices and management programmes.
Such programmes need to successfully identify the risk factors responsible for the increased incidences of foot infections in diabetic patients and include preventative strategies for patients based on these risk factors.
Since a majority of diabetic foot infections develop in ulcers, the prevention of ulcers also becomes an essential component of diabetic foot management strategies.
Jia et al. evaluated the incidence and risk factors for developing infection in patients with uninfected diabetic foot ulcers. The authors performed a secondary analysis of data collected from state-wide clinical diabetic foot database in Queensland, Australia.
Several independent risk factors were identified in the analysis such as deep ulcerations, previous diabetic foot ulcer history, peripheral neuropathy, foot deformity, young age and the female gender.
Foot ulcers that had not healed by 3 months after presentation were found to be a significant risk factor for infection; ulcers that have not healed for a long duration expose a greater volume of soft tissue to infective organisms for a longer period of time.
Barwell et al. advocate the involvement of a multidisciplinary team early in the natural history of the ulcer in order to promote wound healing and reduce the risk of amputation. The authors also suggest tailored antibiotic therapy for targeting the appropriate pathogens in order to treat an active infective process.
There is a risk of treatment failure associated with a delay in the identification of the causative organism. If administered in the absence of infection, antibiotic therapy represents a risk for the selection of drug-resistant pathogens and therapeutic complications.
As mentioned by Wukich et al, some of the essential skills required by an inpatient team providing diabetic foot service include the ability to stage a foot wound, to assess for peripheral vascular disease and neuropathy, to treat wound infection, and to perform debridement.
A preventive podiatric care regimen should be adopted early to detect any impending foot problems in patients with diabetes. This should include a regular assessment of the lower limbs along with debridement of calluses and tissues.
Structural or functional anomalies in the feet can increase frictional forces and create an unequal distribution of pressure on the plantar surface of the foot during the gait cycle.
This can predispose prominent areas of the foot to repetitive trauma, leading to pressure sores that ultimately develop into full-thickness skin ulcerations.
For this purpose, it becomes imperative to reduce pressure on the heels of diabetic patients and prevent iatrogenic pressure sores of the heel. A thorough gait assessment can help in revealing foot postural disparities that need attention.
Once identified, the inclusion of MASS4D® custom foot orthotics in diabetic foot management programmes can be useful in minimising aberrant kinematics that create ‘hot spots’ across the plantar surface of the foot while decreasing the risk of inflammation.
A special MASS4D® Bi-Lam cover can be incorporated into the production of the orthotics to provide a double cushioning effect and protect the feet from unnoticed blistering or ulcerations that could potentially become infected.
The use of therapeutic shoes with pressure-relieving orthotics can help significantly reduce the development of diabetic foot ulcers which consequently lowers the risk of diabetic foot infections.
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