Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review

Abstract

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient's general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

Keywords: Diabetes mellitus; Diabetic foot; Management; Rehabilitation.

Fig. 1.

Clinical photos of diabetic foot ulcer. (A) Lateral aspect. (B) Dorsal aspect. (C) Volar aspect.

Fig. 2.

Magnetic resonance imaging (MRI) of diabetic foot ulcers shows bone marrow edema, diffuse soft tissue edema, and cortical irregularity. (A) Axial T1-weighted MRI shows ill-defined heterogeneous low signal intensity change with cortical destruction in the right 4th toe. (B) Axial T2-weighted fat-suppressed MRI shows high signal intensity in the proximal, middle, and distal phalanx of the right 4th toe which may indicate osteomyelitis.

Fig. 3.

White blood cell single-photon emission computed tomography/computed tomography of diabetic ulcer demonstrates focal abnormal leukocyte accumulations in the right 5th toe which indicates active infection or inflammation with suspicion of bone involvement in the proximal phalanx.

Fig. 4.

Computed tomography angiography shows diffuse atherosclerosis with multifocal ulcers on aortoiliac and lower extremity arteries and near occlusion on the anterior tibial artery and posterior tibial artery.