Diabetic Foot Infection
2008 by Kent Picklesimer, DPM and Seth Rubenstein, DPM

A 35 year old female developed a callus on the bottom of her right foot which began to break down and drain within 3 days. She was initially placed on Keflex, an oral antibiotic, by her primary care doctor. The infection progressed over the following week with swelling and redness extending from her foot into her leg. She was admitted into the hospital and placed on Zosyn, an intravenous antibiotic.

Her medical history was remarkable for insulin dependent diabetes, renal failure and peripheral vascular disease (diminished blood flow). Four years prior, she had an amputation of the right 5th toe.

Good blood flow is necessary to deliver white blood cells and antibiotics to fight infection. Some individuals with diabetes may have poor blow flow to their feet and /or develop neuropathy, a loss of normal sensation. Neuropathy may be so significant that one cannot feel pain otherwise associated with a cut or severe infection.

In this case study, the infection entered from a breakdown of skin on the bottom of the foot, and then traveled under the skin along the tendons and deep spaces of the foot. (Figure 1 and 2).

(Figure 1)

(Figure 2)

 

X-rays reveals no sign of bone infection. An initial surgical debridement was undertaken to remove dead tissue and drain a deep abscess (pocket of infection) which formed in the foot. The infection destroyed tissue just under the skin which required removal of this tissue and some of the overlying skin (Figure 3 and 4).

 

(Figure 3)

(Figure 4)

The expansive wound was covered with a wound VAC, a suction dressing used to remove excess fluid in the wound and promote granulation tissue (early healing) (figure 5).

(Figure 5)

 

Several surgical debridements may be needed to remove unhealthy, dead tissue (Figure 6). After prolonged use of the wound VAC, a healthy granular bed develops (Figure 7).

 

(Figure 6)

(Figure 7)

 

The granular bed allows placement of synthetic skin grafts which help promote in-growth of skin. (Figure 8 and Figure 9).

 

(Figure 6)

(Figure 7)

After multiple graft placements, the wound gradually closes in. The healing process can take significant time. This is influenced by blood flow, nutritional status and co-morbidities such as poor kidney function. The last photograph was taken 6 months into therapy (Figure 10). Unfortunately, the patient moved out of the region before complete healing occurred.


(Figure 10)