What is the best way to mitigate the risk of developing a diabetic foot infection?

From the Guidelines

The best way to mitigate the risk of developing a diabetic foot infection is through a combination of daily foot inspection, proper foot care, and wearing properly fitting shoes, as recommended by the International Working Group on the Diabetic Foot (IWGDF) in their 2023 update 1. To prevent diabetic foot infections, several key strategies can be employed:

• Daily foot inspection to identify any cuts, blisters, redness, swelling, or nail problems, using a mirror if needed to see all areas.
• Washing feet daily with lukewarm water and mild soap, drying thoroughly especially between toes.
• Moisturizing feet but not between toes to prevent fungal growth.
• Trimming toenails straight across and filing edges.
• Always wearing well-fitting shoes and clean socks, never going barefoot, and checking inside shoes before wearing them.
• Maintaining good blood glucose control, as elevated blood sugar impairs immune function and slows healing, as emphasized in the guidelines 1. Some additional recommendations from the IWGDF include:
• Educating patients on proper foot self-care and encouraging them to protect their feet by not walking barefoot, in socks only, or in thin-soled standard slippers, whether at home or outside 1.
• Providing structured education to patients at risk of foot ulceration on appropriate foot self-care for preventing a foot ulcer 1.
• Considering coaching patients to self-monitor foot skin temperatures once per day to identify any early signs of foot inflammation and help prevent a first or recurrent plantar foot ulcer 1.
• Prescribing therapeutic footwear that has a demonstrated plantar pressure-relieving effect during walking to help prevent a recurrent plantar foot ulcer 1. It's essential to note that these preventive measures are crucial because diabetic neuropathy can reduce sensation in feet, allowing injuries to go unnoticed, while poor circulation from diabetes slows healing, creating ideal conditions for infection development. When minor foot problems are detected early, they can be treated before developing into serious infections that might lead to amputation. Regular visits to a podiatrist (at least annually) are also essential for professional assessment and care of calluses or corns. Stop smoking, as it reduces blood flow to the feet, and exercise regularly to improve circulation.

From the Research

Mitigating the Risk of Diabetic Foot Infections

To mitigate the risk of developing a diabetic foot infection, several strategies can be employed:

• Assist the patient in maintaining good glycemic control, as poor glycemic control poses a greater risk for the development of diabetic foot infections 2.
• Encourage the patient to avoid walking barefoot to prevent injuries and infections 3, 4.
• Encourage the patient to wear properly fitting shoes to reduce the risk of foot ulcers and infections 3, 4.
• Initiate antibiotic treatment promptly if an infection is suspected, with the choice of antibiotic depending on the severity of the infection and the likely causative organisms 3, 4, 5, 6.

Preventing Infections

Preventing infections is crucial in managing diabetic foot infections:

• Proper cleansing, debridement, and local wound care are essential in preventing infections 3, 4.
• Systematic assessment, counseling, and comorbidity management are hallmarks of effective secondary prevention for diabetes-related foot infections 5.

Treatment of Infections

If an infection occurs, prompt treatment is necessary:

• Mild infections can often be treated on an outpatient basis with oral antibiotics and local debridement 3, 4, 6.
• More severe infections require hospitalization, intravenous antibiotics, and surgical debridement to fully eradicate the infection 3, 4, 6.
• The duration of antibiotic therapy ranges from a week to over 6 weeks, depending on the severity of the infection and the presence of osteomyelitis 3, 4, 5.