Sore Foot Infection

How it Happens?
Occurs when there is pressure on the feet followed by contamination by foreign materials or colonization by bacteria. Normally, this restricts flow of blood, oxygen, and nutrients to the area. Subsequently the skin cells die. A person with spina bifida has areas of skin which do not have any feeling and often have partial or complete paralysis, and so does not receive these messages. If the pressure continues the blood supply is cut off, causing pressure sores.

Prevention
-Regular Visual Checks
-Suitable wheelchairs, footwear, and braces must be fitted.
-Wearing loose clothing can help prevent rubbing. Tight clothing can reduce circulation
-Ensuring the skin is kept clean and dry will help protect from rashes and bacteria.
-Exercising regularly may improve circulation considerably lessening the risk of pressure sores.

Grade
Grade 1 – skin discolouration, usually red, blue, purple or black.
Grade 2 – some skin loss or damage involving the top-most skin layers.
Grade 3 – necrosis (death) or damage to the skin patch, limited to the skin layers.
Grade 4 – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone

Treatment
Grade 1 and 2 only need pressure relieve and daily check up of the foot. if there is any open wound, clean and dressing to avoid infection. The goals are to provide a moist wound environment, encourage drainage, avoid build-up of necrotic tissue, and keep the bacterial count low.

For infection, the most frequently used medications for foot infections are first-generation cephalosporins, clindamycin (for patients allergic to penicillin), amoxicillin, clavulanate (Augmentin), and levofloxacin (Levaquin) and are directed toward the most common organisms, including S aureus, S epidermidis, and Streptococcus species.

Severe limb-threatening foot infections require aggressive treatment with a combination of local wound care, intravenous antibiotics, and surgical debridement. Infections with open wounds, usually are inoculated with a combination of gram-positive and gram-negative aerobes and anaerobes. These should be treated with broad-spectrum antimicrobials such as ampicillin and sulbactam (Unasyn), ticarcillin and clavulanate (Timentin), or piperacillin and tazobactam (Zosyn) In the patient who is allergic to penicillin, intravenous clindamycin in combination with oral ciprofloxacin, levofloxacin, or gatifloxacin may be used.Wounds that are suspected of containing very aggressive gram-negative organisms should be covered additionally with an aminoglycoside.