Proper Foot Care to Prevent Diabetic Foot Infections

The majority of lower-limb amputations are caused by complications stemming from diabetic foot infections. However, with proper care, patients with diabetic foot can drastically reduce their chances of bone infections or amputation.

One major complication that stems from diabetes is neuropathy. Patients with diabetes are prone to neuropathy, where the nerves in the extremities are affected by the high glucose levels in the blood. This makes it harder for the nerves to function correctly. Reduced sensation makes foot injuries especially risky, as they can go unnoticed and lead to infections. Left untreated for too long, these infections can lead to amputations as the only possible recourse.

Preventing diabetes-related foot conditions starts with recognising at-risk patients. Every patient with diabetes should undergo regular foot examinations at least twice a year. These examinations check for deformities, nail disorders, and skin breaks, and test foot sensation. These examinations can also assess patients’ footwear to determine whether they should make lifestyle adjustments for their condition.

More frequent foot examinations can significantly reduce the risk of further complications, and you can also speak with one of our podiatrists at The Foot Practice. We specialise in treating foot conditions stemming from diabetes. We can help you care for your feet better by providing proper foot care and teaching you what to look for to prevent ulceration and further complications. Other services include callus removal, custom-made orthoses, and optimising glycemic control. 

Common Diabetic Foot Problems That Have Serious Complications

If you lose feeling in your feet, you will be less sensitive to the discomfort and agony caused by minor foot problems and injuries. For example, it may take longer to realise that you have a blister, callus, or cut on your foot. As a result, a common problem can turn into a major issue, such as ulceration.

Bacteria can easily enter your body through injured feet, causing an infection (symptoms include pus, redness, swelling, and discomfort). High blood sugar worsens infected areas, while poor circulation prolongs healing. Gangrene may develop in severe situations, necessitating toe or foot amputation.

Some of the most common causes of diabetic foot conditions we see at The Foot Practice include:

• Bacterial Foot Infections: Diabetes can suppress the immune system, making it harder to fight fungal or bacterial infections. 
• Neuropathy: Patients with diabetes can develop nerve damage, especially in the extremities, as high blood glucose levels can affect nerves. This makes it harder for patients with diabetes to feel their feet, ignoring vital signals like pain.
• Athlete’s Foot: This condition is more common in diabetic patients because of a suppressed immune system. Cracks in the skin resulting from athlete’s foot can lead to infections.
• Bunions: Impaired blood flow to the feet resulting from diabetes makes it harder for the foot to heal and can worsen bunions on the big toe. 
• Calluses: These thickened areas of skin are natural, but if left untreated, especially in patients with diabetes, they can worsen into sores or ulcers, creating opportunities for dangerous infections.
• Corns: On certain parts of the foot, corns can form and cause pain when walking. Pain signals most people to get it treated. For patients with diabetes, damaged nerves can mute the pain, leaving it untreated and leading to worse conditions.
• Foot Ulcers: Ulcers are open wounds that will not heal. They are prime spots for infection and are especially dangerous for patients with diabetes.
• Fungal Nail Infections: If the nail becomes infected, it can change colour and harden. That thickening can cut the skin, leaving it exposed to infection.
• Hammertoes: Toe joints can stiffen, forcing the toe into an arched position. It is uncomfortable and potentially dangerous for patients with diabetes, as it can lead to ulcers or wounds.
• Plantar Warts: These are a highly contagious form of wart that can spread across the foot. Patients with diabetes may not be aware of their plantar warts and accidentally spread them across their bodies.

Many of these diabetic foot infection problems are preventable with proper foot care and regular visits to your podiatrist.

Foot Infections Are Common for People with Diabetes

Patients with diabetes are prone to foot infections, putting them at risk for lower extremity amputation. These infections can be mild, moderate, or severe, and infected diabetic foot ulcers are a leading risk factor for amputation. Prevention of diabetic foot infections requires prompt diagnosis and treatment to avoid further complications (e.g., amputations). Maintaining your overall health is the best strategy.

If a foot infection is found, treat it immediately. This process begins by identifying the specific type of infection based on the location of the inflammation and other diabetic foot infection symptoms.

Interventions such as tests and removals will be referred to the appropriate healthcare provider. These specialists will obtain test samples from the base of the ulcer or a bone biopsy rather than swabbing the wound. They then examine the results to determine the type of infection, such as Staphylococcus aureus and beta-hemolytic streptococci.

After identifying the bacteria, optimal treatment requires surgical debridement, wound management, antibiotics, and correction of metabolic abnormalities. For example, with a callus, this would mean:

• Excising the afflicted tissue
• Providing the proper antibiotic regimen to combat the bacteria if the wound is infected; and
• Correcting footwear that could create abrasions on the foot. Mild infections can be treated simply with oral antibiotics. 

More severe infections beyond calluses will require a more intensive regimen lasting 4 to 12 weeks, possibly delivered via injections into the affected area.

There are three classifications of foot infections, but any infection in a patient with diabetes is potentially serious and must be addressed immediately. They can range from superficial paronychia to deep bone infections. These include osteomyelitis, cellulitis, abscesses, necrotising fasciitis, septic arthritis, and myositis. Diabetic foot infection treatments include the following:

• Antibiotic Therapy: Depending on infection severity, therapy can be oral or intravenous. In the latter case, antibiotics must be injected directly into the affected area to aggressively combat the bacteria. The length of the antibiotic regimen can vary depending on the application method and the type of infection.
• Surgical Treatment: Often, the tissue will have to be surgically removed from diabetic feet to combat the infection. This can range from a simple incision and drainage to more complex debridement and, in extreme cases, amputation.
• Wound Management:  Wound management is not as simple as applying a bandage to the healing area. For patients with diabetes, the wound needs to be dressed to allow subsequent inspection and prevent new infections. The patient could also require additional measures to prevent pressure on the wound area. This can be achieved through total-contact orthoses, modified shoes, braces, splints, or sandals.
• Metabolic Stabilisation: It is also critical to treat the patient’s diabetes to help prevent future complications. This can mean correcting electrolyte imbalances and addressing hyperglycemia, acidosis, or azotemia. Keeping diabetes under control can help eradicate the current infection, prevent future infections, and promote wound healing.

Diabetic Neuropathy or Nerve Damage

When the nerves are damaged, they lose the ability to communicate properly with the muscles in your feet. The regular muscle movement pattern is disrupted, and the muscles become ineffective. This might lead to hammertoes (bends and curls in toes) and difficulty walking.

High blood sugar levels are an inevitable consequence of diabetes, as the body either produces too little insulin to regulate glucose levels or becomes resistant. A wide range of conditions is directly linked to high blood sugar levels in people with diabetes, including poor blood circulation to the lower limbs and extremities and nerve damage, reducing your ability to feel when painful ailments exist. 

Foot infections are more common in patients with diabetes because these factors make it harder for your body to sense pain from a wound on the foot, limit your immune system’s ability to fight infections, and affect your muscles’ normal function. Peripheral neuropathy is especially dangerous in foot infections because it affects the extremities. Thirty to 50 per cent of patients with diabetes develop peripheral neuropathy, putting them at risk of dangerous foot infections.

Neuropathy affects the patient’s ability to sense pain, which is the body’s way of signalling that something is wrong. This makes it likely that patients will not notice abrasions, blistering, or other trauma. Over time, these can become infections. 

Another form of neuropathy is motor neuropathy, in which nerve damage limits muscle function. This can result in conditions such as claw toe, hammertoe, or other deformities that increase the risk of skin ulceration. If the skin is broken, bacteria can reach those exposed tissues. Diabetes also weakens the body’s immune system, making it harder to fight infections, even in superficial wounds. This can cause the infection to spread, especially if left untreated, leading to dangerous complications.

Although most diabetic foot infections begin with an ulcer, localised cellulitis, bacterial skin and tissue infections, and “flesh-eating” necrotising fasciitis can develop without an ulcer or traumatic injury.

Diabetic Charcot Neuropathy

Diabetic Charcot neuropathy, also commonly referred to as diabetic Charcot foot, is a condition that stems from diabetic neuropathy. Infections can arise when the foot loses its ability to detect pain or trauma due to neuropathy.

Diabetic Charcot foot happens when those infections penetrate deeper into the tissue, affecting the ankle, bones, and joints. In essence, it weakens joints and bones, increasing the risk of microtrauma, fractures, or dislocations. This can lead to a physical deformity that creates undue pressure on the foot when walking or putting weight on the afflicted foot.

This deformity dramatically increases the chances of ulceration. Unfortunately, due to the nature of the condition, patients with diabetic Charcot foot have a 50 percent chance of amputation if they develop an ulcer. To prevent this outcome, Charcot’s foot must be treated immediately. The quickest solution is to offload pressure from the afflicted area using a cast, wheelchair, crutches, or a walker. Patients with diabetes must regularly check their feet to catch damage early. 

Diabetic Foot Assessment Helps Maintain Proper Foot Care

Diabetes is a complex disease that can have serious health consequences, including problems with the feet. Proper foot care and preventing diabetic foot conditions are essential to reduce your risk of severe foot ailments. Seek professional advice from a podiatrist or foot doctor if you’re experiencing any foot conditions, before you need major invasive procedures.

At The Foot Practice, our team of foot specialists offers comprehensive diabetic foot screening to help you maintain your health and keep your feet in good condition. Musculoskeletal pain throughout the body often stems from your feet, so stay proactive with foot care by scheduling regular podiatric assessments.

Our experienced podiatrists will perform a thorough neurological, vascular, and skin check to assess your sensitivity, blood pressure, physical appearance, and other aspects of your foot health.

The Foot Practice is a leading diabetic foot podiatry clinic in Singapore. To book a diabetic foot assessment with our foot care professional, contact our diabetic foot clinic today.