Debridement of Invasive Diabetic Foot Infections

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Diabetes pedal infections are too prevalent and will become more so as the numbers of diabetic patients increase. The goal is to prevent amputations or at least to remove as little of the foot as possible. Prompt surgical intervention and better diabetic pedal education will go a long way to achieving that goal.

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Treatment

No matter how extensive the surgical treatment needs to be, there must be adequate control of the blood sugar; however, this can prove to be difficult in light of the infection. Eradication of the infection process aids in decreasing hyperglycemia.

A pedal infection as described previously is a surgical emergency. Gas in the tissue and necrotizing fasciitis makes it more so. Earlier surgical intervention may result in less tissue loss, systemic effects, and shorter hospital stays (Fig. 3). All

Prevention

Once home, the patient needs to be meticulous about blood sugar and hemoglobin A1c control and daily inspection of one's feet. Diabetic pedal education is a hallmark of ulcer prevention [9].

A reliable pedorthotist-orthotist has to be a member of the team. The patient is referred to one when ready to don shoes and begin ambulation. Once dispensed, the foot is inspected intensely, any redness or signs of irritation are reported at once, and the device is modified (Fig. 8).

Summary

Diabetes pedal infections are prevalent and will become more so as the numbers of diabetic patients increase. The goal is to prevent amputations or at least to remove as little of the foot as possible. Prompt surgical intervention and better diabetic pedal education will go a long way to achieving that goal.

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