Diabetic Foot Sepsis

Question 1

Diabetic Foot Problems

Answer 1

Diabetic neuropathy
Peripheral Vascular Disease
Infection

Question 2

Source of sepsis

Answer 2

Simple puncture wound
Nail plate or inter digital space infection
Neuro-ischaemic ulcer (usually metatarsal heads)

Question 3

Summarise DFS

Answer 3

Within the foot the intrinsic muscles of the digits are confined within rigid compartments - bounded by plantar fascia, metatarsal bones and interosseous fascia.
Infection tracks in the soft tissues into this rigid compartment.

If the build up of pus cannot escape

the pressure builds up in this rigid compartment rapidly leading to impairment of capillary blood flow and further ischaemia and further tissue damage.

can rapidly progress to sepsis and ultimately limb loss

Thus, 1. compartment pressure

2. Vascular components
3. Necrotic tissue
4. Limb loss

Question 4

Management

Answer 4

Antibiotic
Gm +ve cocci - S. Aureus, Strep. sp.
Gm -ve bacilli - E. Coli, Klebsiella sp, Enterobacter, Proteus sp, Pseudomonas sp
Anaerobes (bacteriodes)

Rapid surgical debridement, open wound for drainage.

Question 5

Clinical Findings

Answer 5

Pyrexia
Tachycardic
Tachypnoeic
Confused
Kussmaul’s Breathing