Any time a break in the skin occurs, bacteria, fungi, and other pathogens can enter and cause an infection. The foot is an especially rich source of bacteria and invading microorganisms, because your shoes provide them a perfect environment in which to live. Therefore, any time you notice a lesion, ulcer, cut, or sore on your feet, you need to take prompt action to prevent infection. A foot ulcer is the most likely source of infection in the foot. When an ulcer becomes infected, microorganisms can eat through layers of skin and bone tissue to create a deep hole. When the infection spreads or becomes too deep, amputation may be needed.

Symptoms of an infected ulcer include fever, redness, swelling, warmth around the wound, and any sort of drainage or oozing of pus-like material.

An infected ulcer can eat away at your soft tissue and make its way into the bone. If the infection is deep, a part of the foot or even the entire foot or leg may have to be removed to save your life.

If you notice any signs of infection in a foot ulcer, notify your doctor or podiatrist right away. You need to be seen at once before the infection spreads further. You may notice signs of infection even if you don't have an open sore or ulcer. If you notice any redness, swelling, or oozing around your toenail, for example, or at the site of a cut or splinter, you also need to call your doctor right away.

Your doctor will probably first culture material from the sight of infection. You will probably be treated with an antibiotic depending on what sort of organism is causing the infection. This could be an antibiotic or an and fungal agent that can be taken orally, one that is applied topically, or both.

Your doctor will also conduct blood tests to check your blood glucose level and your white cell count. You may also be examined by X ray to make sure there is no sign of bone infection. If the infection is not severe, you will be treated on an outpatient basis, but you should be seen every 2 or 3 days for the first week or so. Most infections will show some improvement in a few days. If you have a soft-tissue infection, you will probably need to take antibiotics for 2 weeks. If the infection has reached the bone, you may need antibiotic therapy for 6 weeks or longer. Make sure to take the prescribed antibiotics for the entire time, even if you think it is getting better. If the infection gets worse, contact your provider immediately, even if you are scheduled for an appointment soon. Signs of a worsening infection include fever or an elevadon in an existing fever, increased pain, redness, warmth, or pus formation.

Besides antibiotics, your doctor takes other steps to encourage the healing of your infected ulcer. For an ulcer to heal, it has to be covered with a healthy layer of tissue, with no dead cells in the way. To ensure this, your doctor may perform a surgical debridement. This means all dead tissue will be removed from the wound. This needs to be done frequently as the wound is healing. Do not attempt to do this yourself!

Your doctor may give you instructions for dressing the wound. You may be given an antibiotic solution or ointment. After cleaning the site of infection, you can either apply the ointment directly or soak a piece of clean gauze in antibiotic solution and apply it to the wound. You will probably want to cover the wound with clean sterile gauze in between dressings.

Also make sure not to walk on your infected foot. If you need to get around, consider using a pair of crutches or even a wheelchair. If you notice any swelling, keep your leg elevated.

While your infection is healing it is important to keep your blood glucose levels under control. This may be a bit of a catch-22 situation. Infection can upset your blood glucose levels, but too much glucose in the blood can impair healing and promote infection. Therefore, test your blood glucose levels frequently and treat hyperglycemia or hypoglycemia if necessary.

PREVENTION

To prevent ulcers or other areas of the foot from becoming infected, make sure to keep any open sore clean and dry. Your doctor may suggest treating any ulcer with antibiotic ointment or solution to prevent

infection. Make sure you avoid walking or further irritating the ulcer. Keep a close eye on the wound for any further changes in its appearance. Also, while your ulcer is healing, keep your blood glucose levels as close to normal as possible.

Nail Infections

The most common nail infection among people with diabetes is onychomycosis. This infection is caused by a fungus and most frequently affects the nail of the big toe. If you can tolerate the unsightly appearance of the toe, it may not seem like that big of a deal. But if left untreated, a fungal toenail can lead to ulceration and infection of the toe itself, which can have serious consequences for someone with diabetes.

SYMPTOMS

The primary symptom of onychomycosis is an unsightly toe. Your toenail may become thick, rough, and yellow. Debris from the infection may collect under the top edge of the nail. After awhile, the entire nail may become soft and crumbly and may even fall off.

Talk to your doctor or podiatrist if you notice any of the symptoms of onychomycosis. Before treating, your doctor will need to accurately diagnose the problem and identify the fungus responsible. This can be done by taking a sample of debris from the nail edge, examining it under a microscope, and culturing it.

TREATMENT

Fungal infections are traditionally difficult to cure. Your doctor may prescribe an oral medication such as terbinafine (Lamisil) or itraconazole (Sporanox). However, these and some other antifungal drugs have side effects. Make sure to discuss these potential side effects with your doctor before taking any new medication. These drugs are newer and have a higher success rate than traditional therapies. You will probably have to take the drug for up to 12 weeks. Following this regimen, 80 percent of nails are successfully treated. However, the condition may reoccur, especially if you discontinue treatment early. Don't be surprised if it takes your new toenail up to 2 years to grow out normally once the fungus has been destroyed.

PREVENTION

To prevent fungal infections, make sure you keep your feet clean and dry. Keep your toenails well trimmed and wear correctly fitted shoes. Visit your podiatrist regularly for a routine foot examination. Also, keep your blood glucose levels under control and eat a well-balanced diet.

Above information is from the book The Diabetes Problem Solver available form the American Diabetes Association.