RESPONSE: A diabetic foot infection is a serious concern. Infections typically refer to bacteria, but keep in mind many other organisms can create an infection: fungus, viruses, parasites, insects, etc. Bacteria are by far the most prevalent. Some bacteria are harmful while others are beneficial. Keep in mind; bacteria are all around us, on the floor, on doorknobs, on keys, on dishes, on pens, etc. You get the idea.



The usual route of infection for a diabetic typically begins with a break in the skin. Let's use an example. Harry is a diabetic preparing for his grandson's wedding in just over a months time. He is trying on a pair of rental shoes that come with his tuxedo. He unknowingly creates a small cut on the top of his foot while trying on a pair of shoes that are too small for him. Because he is diabetic and has sensory neuropathy, he is unable to feel this cut and continues to go about his day, oblivious to the fact that he has a small opening on the top of his foot. Also, because he is diabetic, his immune system is not functioning optimally and is unable to mount the proper immune response that a healthy individual would be able to do.

For an infection to occur either the friendly bacteria has multiplied to dangerous levels or the dangerous bacteria has gain a foothold against the body. Obviously with a diabetic, this can easily occur because the normal immune system response is muted in a diabetic. Otherwise healthy bacteria can also prove harmful because they are multiplying unchecked. Additionally, this condition can also lead to large numbers of several different types of bacteria, which also limits the body's immune response. Bacteria can be seeded by openings in the skin, corns, calluses, punctures, small fissures, ingrown nails, burns, and a variety of other methods.

So going back to our example, the bacteria have now seeded themselves on the top of Harry's foot from the used rental shoe. They have begun to rapidly multiply after a few days and Harry is still unaware that he has a problem. After about a week, Harry begins to complain of a low grade fever and notices that he has some smelly yellow fluid on his white socks. Harry is no dummy; he already is a patient of a local podiatrist, a physician who has special training in all aspects of foot, ankle, and leg conditions. He makes an appointment to see the doctor the following week.

So what does an actual diabetic infection look like? Well, first, there typically is a sore or ulcer present. Around this ulcer, there is usually red and inflamed tissue. Also, there may be no swelling, some swelling, or significant swelling. There may also be warmth to the touch. Additionally, pus or foul smelling fluid may be draining from the ulcer. The skin in the area of the ulcer may appear to be flaking or peeling away. Also, in serious situations, there may be red streaking up the limb. There may or may not be pain because of sensory neuropathy for the diabetic patient. Diabetics cannot rely on sensation to realize that they have a problem. They must rely on their vision to detect any abnormalities on their feet. Even their sense of smell may not be that good at an older age. People with serious infections may have nausea, vomiting, fever, and/or chills.

Harry should have inspected his feet daily. Had he followed his doctors? instructions to check his feet everyday because he is diabetic, he may have caught the infection in time when it was at a manageable level. But because Harry didn't realize his problem until he noticed the yellow drainage on his sock, too much time had elapsed. The bacterium had a lot of time to seed it, multiply it, and has overcome any weakened immune response directed against it. This is where daily foot inspections are so vitally important. Missed infections can worsen to the point of amputation or hospitalization.