From the Guidelines
For a diabetic patient with a red cut on the foot, I strongly recommend prompt medical evaluation and treatment with thorough wound cleaning, topical antibiotics, and oral antibiotics if necessary, as well as elevation and off-loading of the affected foot, to prevent infection and complications. The patient's foot should be cleaned with saline solution and covered with a sterile dressing that should be changed daily [ 1 ]. According to the 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections, clinicians should diagnose infection based on the presence of at least 2 classic symptoms or signs of inflammation, such as erythema, warmth, tenderness, pain, or induration, or purulent secretions [ 1 ].
The treatment should include application of a topical antibiotic such as mupirocin 2% ointment three times daily. However, the 2024 guidelines on interventions to enhance healing of foot ulcers in people with diabetes recommend against using topical antiseptic or antimicrobial dressings for wound healing of diabetes-related foot ulcers [ 1 ]. Oral antibiotics are often necessary, with amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days being a common first-line option. The patient should elevate the foot when sitting or lying down, avoid putting weight on the affected foot, monitor blood glucose levels closely, and check the wound daily for signs of worsening infection.
Some key points to consider in the management of diabetic foot ulcers include:
- Assessing the affected limb and foot for arterial ischemia [ 1 ]
- Evaluating the foot for deformities such as Charcot arthropathy, claw or hammer toes, bunions, or callosities [ 1 ]
- Assessing for neuropathy, especially the loss of protective sensation [ 1 ]
- Using sharp debridement as the standard of care for wound healing [ 1 ]
- Considering the use of adjunctive therapies such as hyperbaric oxygen or topical oxygen in specific situations [ 1 ]
The patient should seek immediate medical attention if the redness spreads, if there's increased pain, swelling, warmth, pus, or if fever develops. Diabetic patients are at higher risk for foot infections due to peripheral neuropathy and potentially compromised circulation, which can delay healing and allow infections to progress rapidly [ 1 ]. Even a small cut can quickly develop into a serious infection that may lead to complications like cellulitis, osteomyelitis, or even amputation if not properly treated.
From the Research
Diagnosis and Treatment of Diabetic Foot Infections
- Diabetic foot infections are a common complication of diabetes, causing significant morbidity 2.
- Indicators of infection include erythema, induration, tenderness, warmth, and drainage 2.
- For a diabetic patient with a cut on the foot that is red, it is essential to consider the patient's risk factors, such as the presence of foot ulcers greater than 2 cm, uncontrolled diabetes mellitus, poor vascular perfusion, and comorbid illness 2.
Antibiotic Therapy
- Antibiotic therapy should cover commonly isolated organisms, such as Staphylococcus aureus and Streptococcus agalactiae, and reflect local resistance patterns, patient preference, and the severity of the foot infection 2.
- Mild and some moderate infections may be treated with oral antibiotics, while severe infections require intravenous antibiotics 2.
- Treatment duration is typically one to two weeks and is longer for slowly resolving infections or osteomyelitis 2.
Wound Care and Management
- Wound care should include debridement, off-loading, and the use of antimicrobial dressings 3, 4.
- Antimicrobial dressings may increase the number of diabetic foot ulcers healed over a medium-term follow-up period 3.
- A multidisciplinary management approach, including a team of specialists, is recommended for managing infected diabetic foot wounds 5, 4.