diabetestalk.net

Diabetic Foot Ulcer Fever

How To Treat Common Diabetic Foot Ulcer Symptoms

How To Treat Common Diabetic Foot Ulcer Symptoms

How to Spot and Treat Common Diabetic Foot Ulcer Symptoms If left untreated, diabetic foot ulcers can cause permanent damage that affects your mobility. Approximately 15% of people with diabetes suffer from foot ulcers, according If left untreated, diabetic foot ulcers can cause permanent damage that affects your mobility. Approximately 15% of people with diabetes suffer from foot ulcers , according to the American Podiatric Medical Association (APMA). Knowing how to recognize diabetic foot ulcer symptoms is crucial, because untreated ulcers can lead to permanent disfigurement. APMA reports that diabetic wounds are the leading cause of non-traumatic lower extremity amputations in the United States. However, proper wound care can help reduce the chances of surgical intervention, infection, and foot deformation. The following information will help you recognize wound symptoms and find an effective diabetic foot ulcer treatment . Neuropathy occurs when blood vessels supplying nerves with oxygen and nutrients are damaged. The feet of a person with diabetes are particularly susceptible to neuropathy because of insufficient blood flow and unchecked blood sugar. These conditions can destroy nerve cells and cause pain, tingling, and numbness. People with diabetic neuropathymay lose enough sensation in their feet that they cannot feel the pain or the intense itching of foot injuries. Foot issues like ingrown toenails or dry skin cuts may go unnoticed unless you check your feet at least once a day for open wounds or other trauma. Diabetes also interferes with normal wound healing. Skin breaks on the feet are affected by diminished blood flow and the restriction of white blood cells that are needed to initiate the wound healing process. Diabetic foot ulcers almost always form on Continue reading >>

Diabetic Foot Complications

Diabetic Foot Complications

Diabetic foot complications, including ulcers and infections, are a common and costly complication of diabetes mellitus. The majority of diabetic foot ulcers are caused by repetitive trauma sustained during activity on a structurally abnormal, insensate foot. Ulcers act as a portal of entry for bacterial infections. Preventing and/or healing ulcers helps prevent infections and thereby minimize limb loss risk. Initial evaluation and early management may be by primary care providers; however, there should be a low threshold to refer to a interdisciplinary diabetic foot care clinic or inpatient unit. This is particularly true if there is any loss of sensation or signs of peripheral artery disease. Leg amputation should be avoidable in the majority of cases and is rarely the first-choice option for ambulatory patients. The term diabetic foot complications encompasses the conditions of diabetic foot ulcer (i.e., a full-thickness epithelial defect below/distal to the ankle), [1] Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev. 2004 May-Jun;20(suppl 1):S90-5. and diabetic foot infections (i.e., any soft-tissue or bone infection occurring in the diabetic foot, including osteomyelitis). previous history of partial foot (toe) amputation limited ankle joint mobility (ankle equinus) Continue reading >>

Diabetic Foot Ulcers Heal With Shock Wave Therapy

Diabetic Foot Ulcers Heal With Shock Wave Therapy

Diabetic Foot Ulcers Heal With Shock Wave Therapy The FDA has approved the first shock wave device indicated for patients with diabetic foot ulcers. Marketed as the Dermapace System, the device uses a handheld probe to deliver high-energy pulses similar to sound waves to the wounds surface. According to the manufacturer, Sanuwave Health Inc , of Alpharetta, Georgia, the device increases perfusion and arteriogenesis, angiogenesis, biofilm disruption, and growth factor upregulation, which help regenerate skin and musculoskeletal and vascular structures. Treatment consists of 4 to 8 brief, noninvasive applications given over 2 to 10 weeks. Monitoring and usual care are required afterward. The device is indicated for adults with diabetes who have foot ulcers lasting more than 30 days. The FDA noted that about 25% of people with diabetes will develop a foot ulcer. Poor circulation or a foot infection that doesnt respond to treatment sometimes results in amputation. Officials at the FDA said the agency reviewed clinical data from 2 trials that involved 336 patients with diabetes. The treatment group received usual care consisting of wet-to-dry dressings or debridement and the shock wave therapy. The control group was treated with usual care and sham shock wave therapy. Some patients blood glucose was well controlled while others blood glucose was not. The trials primary end point was complete wound closurefull skin reepithelialization without the need for drainage or dressingswithin 12 weeks of starting treatment. After 24 weeks, 44% of patients in the Dermapace group who received 1 to 7 treatments met the end point compared with 30% in the control group. The most common adverse events associated with the Dermapace System were pain during treatment, local bruising and numbne Continue reading >>

Diabetic Foot Care Article

Diabetic Foot Care Article

A A A Diabetes mellitus (DM) represents several diseases in which high blood glucose levels over time can damage the nerves, kidneys, eyes, and blood vessels. Diabetes can also decrease the body's ability to fight infection. When diabetes is not well controlled, damage to the organs and impairment of the immune system is likely. Foot problems commonly develop in people with diabetes and can quickly become serious. With damage to the nervous system, a person with diabetes may not be able to feel his or her feet properly. Normal sweat secretion and oil production that lubricates the skin of the foot is impaired. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. Sores may develop. Damage to blood vessels and impairment of the immune system from diabetes make it difficult to heal these wounds. Bacterial infection of the skin, connective tissues, muscles, and bones can then occur. These infections can develop into gangrene. Because of the poor blood flow, antibiotics cannot get to the site of the infection easily. Often, the only treatment for this is amputation of the foot or leg. If the infection spreads to the bloodstream, this process can be life-threatening. People with diabetes must be fully aware of how to prevent foot problems before they occur, to recognize problems early, and to seek the right treatment when problems do occur. Although treatment for diabetic foot problems has improved, prevention - including good control of blood sugar level - remains the best way to prevent diabetic complications. People with diabetes should learn how to examine their own feet and how to recognize the early signs and symptoms of diabetic foot problems. They should also l Continue reading >>

Diabetic Foot Infections: Current Concept Review

Diabetic Foot Infections: Current Concept Review

Diabetic foot infections: current concept review 1Center for Healing and Amputation Prevention (CHAMP), University of Pittsburgh Medical Center, Mercy Campus, Pittsburgh, PA, USA 1Center for Healing and Amputation Prevention (CHAMP), University of Pittsburgh Medical Center, Mercy Campus, Pittsburgh, PA, USA 2Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 1Center for Healing and Amputation Prevention (CHAMP), University of Pittsburgh Medical Center, Mercy Campus, Pittsburgh, PA, USA 2Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA *Dane K. Wukich, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 2100 Jane St, Suite 7100 Pittsburgh, PA 15203, USA. Email: [email protected] Received 2012 Mar 24; Revised 2012 Apr 15; Accepted 2012 Apr 15. Copyright 2012 Kimberlee B. Hobizal and Dane K. Wukich This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high mo Continue reading >>

Diabetes And Infection: How To Spot The Signs

Diabetes And Infection: How To Spot The Signs

Diabetes can slow down your body's ability to fight infection. The high sugar levels in your blood and tissues allow bacteria to grow and help infections develop more quickly. Common sites for these problems are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment can prevent more serious issues later on. What to Look For Most infections in people with diabetes can be treated. But you have to be able to spot the symptoms. Tell your doctor immediately if you have any of the following: Fever over 101 F Pain, tenderness, redness, or swelling Wound or cut that won't heal Red, warm, or draining sore Sore throat, scratchy throat, or pain when you swallow Sinus drainage, nasal congestion, headaches, or tenderness along upper cheekbones White patches in your mouth or on your tongue Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy" Painful or frequent peeing or a constant urge to go Bloody, cloudy, or foul-smelling pee *CGM-based treatment requires fingersticks for calibration, if patient is taking acetaminophen, or if symptoms/expectations do not match CGM readings, and if not performed, may result in hypoglycemia. Please see important risk and safety information. Continue reading >>

Diabetic Foot Infections Can Be Reduced With Proper Treatment

Diabetic Foot Infections Can Be Reduced With Proper Treatment

Diabetics often suffer from foot infections, yet appropriate care can save limbs, and ultimately lives, according to the Infectious Diseases Society of America's new guidelines. The mortality rate for diabetics due to poor treatments of infected foot wounds that can subsequently lead to lower extremity amputation is worse than for the majority of cancers, given that around 50% of diabetics with foot amputations die within five years. The IDSA diabetic foot infection guidelines published in the journal Clinical Infectious Diseases have now revealed that about half of these lower extremity amputations can in fact be prevented through proper care of foot infections. Diabetics generally suffer from poor blood circulation, which means their sense of touch or pain sensitivity can be greatly compromised. For instance, a simple sore caused by a rubbing shoe or a cut can easily go unnoticed and become worse. One in four diabetics will have a foot ulcer, i.e. an open sore in their lifetime, which can easily become infected. If left untreated, these infections can spread and kill soft tissue and bone, which means that the dead and infected tissue needs to be surgically removed, and in severe cases, this means amputation of the toe, foot, or even part of the leg. Almost 80% of all non-traumatic amputations are performed in people with diabetes, and 85% of these amputations start with an open foot sore. Leading author, Benjamin A. Lipsky, MD, chair of the review panel, guidelines and professor of medicine at Washington University and VA Puget Sound in Seattle declared: "Lower extremity amputation takes a terrible toll on the diabetic patient. People who have had a foot amputated often can no longer walk, their occupational and social opportunities shrink, and they often become depre Continue reading >>

Diabetic Foot Infections

Diabetic Foot Infections

Author: Michael Stuart Bronze, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Compromise of the blood supply from microvascular disease, often in association with lack of sensation because of neuropathy, predisposes persons with diabetes mellitus to foot infections. These infections span the spectrum from simple, superficial cellulitis to chronic osteomyelitis. The radiograph below demonstrates a foot lesion in a patient with diabetes. Chronic diabetic ulceration with underlying osteomyelitis. Plain film radiograph exhibiting cortical disruption at the medial aspect of the first MTP joint. Diabetic foot infections typically take one of the following forms: Tender, erythematous, nonraised skin lesions are present, sometimes with lymphangitis Lymphangitis suggests group A streptococcal infection Bullae are typical of Staphylococcus aureus infection, but occasionally occur with group A streptococci The patient may be acutely ill, with painful induration of the soft tissues in the extremity In mixed infections that may involve anaerobes, crepitation may be noted over the afflicted area Extreme pain and tenderness may indicate compartment syndrome or clostridial infection (ie, gas gangrene) The tissues are not tense, and bullae may be present Unless peripheral neuropathy is present, the patient has pain at the site of the involved bone Usually, fever and regional adenopathy are absent The patient's temperature is usually less than 102F Pain may or may not be present, depending on the degree of peripheral neuropathy Deep, penetrating ulcers and deep sinus tracts (diagnostic of chronic osteomyelitis) are usually located between the toes or on the plantar surface of the foot The medial malleoli, shins, or heels are not usually sites of involvement See Clinical Presen Continue reading >>

Diabetic Foot Ulcer And Poor Compliance: How Would You Treat?

Diabetic Foot Ulcer And Poor Compliance: How Would You Treat?

Diabetic foot ulcer and poor compliance: How would you treat? J Fam Pract. 2005 September;54(9):768-776 Department of Family Medicine, University of Nebraska Medical Center, Omaha University of Nebraska College of Medicine, Department of Family Medicine, Omaha 1. Sumpio BE. Primary care: foot ulcers. N Engl J Med 2000;343:787-793. 2. Lipsky BA. Medical treatment of diabetic foot infections. Clin Infect Dis 2004;39:S104-S114. 3. Brem, Harold, Sheehan P, Boulton AJM. Protocol for treatment of diabetic foot ulcers. Am J Surg 2004;187:1S-10S. 4. Ulbrecht JS, Cavanagh PR, Caputo GM. Foot problems in diabetes: an overview. Clin Infect Dis 2004;39:S73-S82. 5. Caputo GM, Cavanagh PR, Ulbrecht JS, et al. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994;331:854-860. 6. Smith RG. Validation of Wagners classification: a literature review. Ostomy Wound Manage 2003;49:54-62. 7. Foster AVM, Bates M, Doxford M, Edmonds ME. Should oral antibiotics be given to clean foot ulcers with no cellulitis? Abstracts of the 3rd International Symposium of the Diabetic Foot (1998). 8. Tice AD, Hoaglund PA, Shoutlz DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med 2003;114:723-728. 9. Zimmerman J. Osteomyelitis. Am Acad Fam Pract Home Study 2005; Clinical Update 308. 10. Alazraki N, Dalinka MK, Berquist TH, et al. Imaging diagnosis of osteomyelitis in patients with diabetes mellitus. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215:303-310. 11. Lipman BT, Collier BD, Carrera GF, et al. Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography. Clin Nucl Med 1998;23:77-82. 12. Newman LG, Waller J, Palestro CJ, et al. Unsuspecte Continue reading >>

Diabetic Foot Problems

Diabetic Foot Problems

What foot problems can be caused by diabetes? Diabetes mellitus can cause serious foot problems. These conditions include diabetic neuropathy (loss of normal nerve function) and peripheral vascular disease (loss of normal circulation). These two conditions can lead to: Diabetic foot ulcers: wounds that do not heal or become infected Infections: skin infections (cellulitis), bone infections (osteomyelitis) and pus collections (abscesses) Gangrene: dead tissue resulting from complete loss of circulation Charcot arthropathy: fractures and dislocations that may result in severe deformities Amputation: partial foot, whole foot or below-knee amputation What are the symptoms of a diabetic foot problem? ​Symptoms of neuropathy may include the loss of protective sensation or pain and tingling sensations. Patients may develop a blister, abrasion or wound but may not feel any pain. Decreased circulation may cause skin discoloration, skin temperature changes or pain. Depending on the specific problem that develops, patients may notice swelling, discoloration (red, blue, gray or white skin), red streaks, increased warmth or coolness, injury with no or minimal pain, a wound with or without drainage, staining on socks, tingling pain or deformity. Patients with infection may have fever, chills, shakes, redness, drainage, loss of blood sugar control or shock (unstable blood pressure, confusion and delirium). How do some of these complications develop? ​Neuropathy is associated with the metabolic abnormalities of diabetes. Vascular disease is present in many patients at the time of diagnosis of diabetes. Ulcers may be caused by external pressure or rubbing from a poorly fitting shoe, an injury from walking barefoot, or a foreign object in the shoe (rough seam, stone or tack). Infecti Continue reading >>

Clinical Signs Of Infection In Diabetic Foot Ulcers With High Microbial Load

Clinical Signs Of Infection In Diabetic Foot Ulcers With High Microbial Load

Go to: DFUs are a common type of chronic wound. The prevalence of diabetes is 6.3% in the general population, 8.7 among persons 20 years of age and older (Center for Disease Control and Prevention, 2003), and 17% among veterans enrolled in Veterans Health Administration (VHA) (Reiber et al., 2001). Approximately 15–20% of persons with diabetes will develop a DFU in their lifetime (American Diabetes Association, 1999; Boulton et al., 1999). Persons with diabetes are at higher risk for developing infections (Grossi et al., 1991; Josephs et al., 1993; Reiber et al., 2001; Wymenga et al., 1992) due to the effects of hyperglycemia on leukocyte function (Pecoraro & Chen, 1987). Outcomes associated with infection-related complications among persons with DFUs are striking. For example, 14–24% of persons with DFUs will have an amputation (ADA, 1999), and complications associated with foot ulcers account for 20–25% of all hospital days for persons with diabetes (Reiber, 1995). Nonetheless, the identification and diagnosis of DFU infection, like chronic wound infection in general, remains a complex and unsolved problem (Bowler, 2003). During the past 10 years, 50 papers in the nursing and medical literature were devoted specifically to identifying and diagnosing infection in the chronic wound. Although a few of these have provided data to advance the knowledge base in this area, most address the problems associated with the uncertainty regarding the definition of infection, the issues surrounding wound cultures, rationales supporting best culturing techniques, and the role of clinical signs of infection. The reiteration of these issues underscores the continued frustration felt by clinicians and experts in screening chronic wounds for localized infection. The problem is that Continue reading >>

The Treatment Of Diabetic Foot Infections: Focus On Ertapenem

The Treatment Of Diabetic Foot Infections: Focus On Ertapenem

The treatment of diabetic foot infections: focus on ertapenem Diabetic Foot Clinic, King’s College Hospital, Denmark Hill, London, UK Correspondence: Michael Edmonds, Diabetic Foot Clinic, King’s College Hospital, Denmark Hill, London, UK, Email [email protected] Copyright © 2009 Edmonds, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gram-negative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is a Continue reading >>

What Causes Fever In People With Diabetes?

What Causes Fever In People With Diabetes?

Fever is often a sign of infection somewhere in the body. It is an important immune system function that sometimes serves to kill the invading organism. People with diabetes are prone to several types of infection. It is important for a person with diabetes to seek treatment for infection or a chronic fever of unknown origin, as an acute illness can make diabetes more difficult to manage. Video of the Day The Merck Manual for Healthcare Professionals notes that people with diabetes have an increased risk for urinary tract infections. The severity of this type of infection is often worse in people with diabetes than that found in a person without diabetes. Often, a urinary tract infection affects the bladder, a condition called cystitis. A low-grade fever may develop with cystitis and other urinary tract infections. Treatment typically consists of oral antibiotics. Merck indicates that a person with diabetes may need a longer course of treatment. Thrush is a yeast infection that occurs in moist areas of the body, such as the mouth. MedlinePlus, a website maintained by the National Institutes of Health, indicates that a person with diabetes is at increased risk of getting thrush in the mouth because elevated glucose levels in saliva serve as food for the yeast. Oral thrush may cause a low-grade fever, explains the text, "Medical-Surgical Nursing." A prescription anti-fungal mouth rinse or lozenge is often prescribed to treat oral thrush. Foot problems are a serious concern for people with diabetes. They can easily develop because of a combination of poor circulation and nerve damage that allows a minor problem to become worse. Foot ulcers can easily become infected, characterized by redness, foul-smelling drainage or dead tissue. A fever may be present, but sometimes a di Continue reading >>

Diabetic Foot Ulcers

Diabetic Foot Ulcers

WHAT YOU NEED TO KNOW: What is a diabetic foot ulcer? A diabetic foot ulcer is an open sore that can develop anywhere on your foot or toes. The ulcers usually develop on the bottom of the foot. You may first notice drainage on your sock. Drainage is fluid that may be yellow, brown, or red. The fluid may also contain pus or blood. What increases my risk for a diabetic foot ulcer? Blood sugar levels that are not controlled Nerve damage and numbness in your feet Poor blood flow A foot deformity, such as a bunion or hammertoe Calluses or corns on your feet or toes A decrease in vision that keeps you from seeing your feet clearly Being overweight Cigarette smoking or alcohol use How is a diabetic foot ulcer diagnosed and treated? Your healthcare provider will ask about your symptoms and examine your foot and the ulcer. He may check your shoes. He may also send you to a podiatrist (foot doctor) for treatment. The goal of treatment is to start healing your foot ulcer as soon as possible. The risk for infection decreases with faster healing. Do the following to help your ulcer heal: Prevent or treat an infection. A bandage will be put on your ulcer. Your healthcare provider will give you instructions on changing your bandage. You may need to clean the wound and change the bandage daily. The bandage may contain medicines to help your ulcer heal. You may be asked to put medicine on your foot ulcer before you put on the bandage. The medicine may also prevent growth of tissue that is not healthy. If you have an infection, your healthcare provider will give you antibiotics to treat it. Have any dead tissue debrided (removed). The removal of dead skin and tissue around your foot ulcer can help with healing. Manage your blood sugar levels and other health problems. Your blood sugar, b Continue reading >>

Diabetic Foot Ulcer

Diabetic Foot Ulcer

People with diabetes have an increased chance of developing foot problems such as a foot ulcer. This is commonly known as 'diabetic foot'. A foot ulcer is a sore that develops on the foot, usually below the ankle. Key points: About 10 of every 100 people with diabetes (10%) will develop a foot ulcer some time during their lifetime (1). Foot ulcers occur most often on the ball of the foot or on the bottom of the big toe. Treatment of the foot ulcer will depend on the severity of the wound. Proper foot care will help prevent problems with your feet. Causes of diabetic foot ulcer People with diabetes have an increased chance of developing foot ulcers because of: poor circulation or poor blood supply to the blood vessels in the legs (also called peripheral artery disease) nerve damage (also called neuropathy). Poor circulation Diabetes causes the blood vessels of the leg and foot to harden and narrow. This impairs the blood supply to the foot, which may lead to ulceration, and healing of the wound is quite slow. Apart from diabetes, poor circulation is aggravated (made worse) by smoking, hypertension (high blood pressure) and high cholesterol. Nerve damage High blood glucose levels causes damage to the nerves. This results in reduced or complete loss of feeling in the foot or leg. Because of the lack of feeling or sensation, sores, cuts, bruises or any injury to the foot is often unnoticed. Signs and symptoms of diabetic foot Foot ulcers occur most often on the ball of the foot or on the bottom of the big toe. They may also develop on the side of the foot, usually because of poor fitting shoes. The ulcers are usually painless. Not all diabetic foot ulcers may be infected (presence of bacteria in the ulcer), but people with diabetes are at high risk of developing infection o Continue reading >>

More in diabetes