Diagnosis and Management of Infection in the Diabetic Foot

Infections of the foot are common in persons with diabetes mellitus, occurring in up to 7 percent yearly in tertiary foot clinics. Diabetes appears to have multi-factorial effects on various parts of the immune system, especially on the cells that mediate innate immunity. Both the International Working Group on the Diabetic Foot (IWGDF) and the Infectious Diseases Society of America (IDSA) recommend basing the diagnosis of diabetic foot infection on clinical findings. The presence of clinically significant ischemia to the affected foot often increases the severity of the infection. Systemic antimicrobial therapy is necessary, but by itself not sufficient, to cure most infections. Antibiotics must be combined with appropriate debridement, pressure off-loading, and frequently one or more surgical procedures. Osteomyelitis is an infection of bone with involvement of bone marrow. In the diabetic foot these infections usually occur by contiguous spread of microorganisms into bone from a chronic ulcer.