Foot Infections

Abstract

Infections of the foot are very variable, some being complex in nature, causing pain, morbidity, and even mortality. In patients with diabetes mellitus, foot infections are common, ranging from chronic bacterial or fungal infections to serious limb-threatening ones. To manage infections, a sound knowledge of anatomy is essential. This article reviews the problems with respect to recent evidence and provides pathways to management and suggestions of changes with potential to wound healing.

Keywords

foot infections lower extremity wounds diabetes bacterial infection fungal infections

Get full access to this article

View all access options for this article.

References

Fitzgerald RH Jr , Cowan JOE . Puncture wounds of the foot. Orthop Clin North Am 1975;6:965-972.

Houston AN , Roy WA , Faust RA , et al. Tetanus prophylaxis in the treatment of puncture wounds in patient in the Deep South. J Am Trauma 1962;2:439-450.

Shuman CR . Foot disorders in diabetics. Diabetes 1983;74:109-113, 116, 119-120.

Fearon J , Campbell DR , Hoar CJ Jr , et al. Improved results with diabetic below-knee amputations. Arch Surg 1985;120:777-780.

Fry DE , Marek JM , Langsfeld M. Nonoperative management of lower extremity arterial disease, part 1: infections in the ischemic lower extremity. Surg Clin North Am 1998;78:466.

Weaver TD , Ton Vy Minh DPM , Pham V Thuan DPM . Ingrowing toenails: management practices and research outcomes. Int J Lower Extremity Wounds 2004;3:22-34.

Habif TP . Clinical dermatology: a color guide to diagnosis and therapy. 3rd ed. St. Louis: Mosby-Year Book; 1995.

Baldwin G , Colbourne M. Puncture wounds. Pediatr Rev 1999;20:21-23.

Patzakis MJ , Wilkins J , Brien WW , Carter VS . Wound site as a predictor of complications following deep nail punctures to the foot. West J Med 1989;150:545-547.

10.

Steele MT , Tran LV , Watson WA , Muelleman RL . Retained glass foreign bodies in wounds: predictive value of wound characteristics, patient perception, and wound exploration. Am J Emerg Med 1998;16:627-630.

11.

Manthey DE , Storrow AB , Milbourn JM , Wagner BJ . Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Ann Emerg Med 1996;28:7-9.

12.

Barbosa P. Plantar verrucae and HIV infection . Clin Podiatr Med Surg 1998;15:317-327.

13.

Hoover TJ , Siefert JA . Soft tissue complications of orthopedic emergencies. Emerg Med Clin North Am 2000;18:115-139.

14.

Revathi G , Puri J , Jain BK . Bacteriology of burns. Burns 1998;24:347-349.

15.

Hill MK , Sanders CV . Skin and soft tissue infections in critical care. Crit Care Clin 1998;14:251-262.

16.

Rabinowitz RP , Caplan ES . Management of infections in the trauma patient. Surg Clin North Am 1999;79:1373-1383.

17.

Faglia E , Favales F , Aldeghi A , et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer: a randomized study. Diabetes Care 1996;19:1338-1343.

18.

Mackowiak P , Jones S , Smith J. Diagnostic value of sinus tract cultures in chronic osteomyelitis. JAMA 1978;239:2772-2775.

19.

Centers for Disease Control and Prevention . Lower extremity amputations among persons with diabetes mellitus: Washington, 1988. MMWR Morb Mortal Wkly Rep 1991;40:737-739.

20.

Calhoun JH , Cantrell J , Cobos J , et al. Treatment of diabetic foot infections: Wagner classification, therapy, and outcome. Foot Ankle 1988;9:101-106.

21.

Pecoraro RE , Reiber GE , Burgess EM . Pathways to diabetic limb amputation: basis for prevention. Diabetes Care 1990;13:513-521.

22.

Armstrong DG , Lavery LA , Harkiess LB . Validation of a diabetic wound classification system: the contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998;21:855-859.

23.

Grayson ML , Gibbons GW , Balogh K , Levin E , Karchmer AW . Probing to bone in infected pedal ulcers. JAMA 1995;273:721-723.

24.

Seabrook GR , Towne JB . Management of foot lesions in the diabetic patient. Rutherford Vascular Surg 1998;1:1093-1101.

25.

Fox IM , Zeiger L . Tc-99m-HMPAO leukocyte scintigraphy for the diagnosis of osteomyelitis in diabetic foot infections. J Foot Ankle Surg 1993;32:591-594.

26.

Ma LD , Frassica FJ , Bluemke DA , et al. Ct and MRI evaluation of musculoskeletal infection. Crit Rev Diagn Imaging 1997;1136:535-568.

27.

Lorber B. Gas gangrene and other clostridium-associated diseases. In: Mandell G , Bennett JE , editors. Mandell and Bennett’s principles and practices of infectious diseases. 5th ed. Philadelphia: Churchill and Livingston; 2000. p. 2549-2559.

28.

Armstrong DG , Nguyen HC , Larvey LA , van Schie CH , Boulton AJ , Harkless LB . Offloading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001;24:1019-1022.

29.

Steed DL . Foundations of good ulcer care. Am J Surg 1998;176:20S-25S.

30.

Ramasastry SS . Chronic problem wounds. Clin Plastic Surg 1998;25:367-396.

31.

Meekes JR . Autolytic debridement. In: Cherry GW , Harding KG , Ryan TJ , editors. Wound bed preparation. London: Royal Society of Medicine Press; 2001. p. 105-108.

32.

Rodeheaver G. Controversies in topical wound management . Wounds Comp Clin Res Prac 1989;1:19-27.

33.

Armstong DG , Boulton AJM , Jospeh WS , Lipsky BL . Diagnosing and treating osteomyelitis. Podiatry Today 2003;8-12.

34.

Lamb H , Wiseman L. Pexiganin acetate. Drugs 1998;56:1047-1052.

35.

Benedetti L. New biometricals from hyaluronic acid . Medical Defence Technol 1994;11:32-37.

36.

Benedetti L , Cortivo R , Berti T , et al. Biocompatibility and biodegradation of different derivates (Hyaff) implanted in rats. Biomaterials 1993;14:1154-1160.