Predicting the severity of diabetic foot infections

    When one presents with a diabetic foot infection there is always the fear of amputation.  Diabetics that have infections in their feet are at significantly increased risk for amputation.  The challenge is to make sure that the patient can be treated with his minimal amount of surgery as possible saving as much of the leg as possible.

    Over the years research has been done in the field of predicting the severity of infection to see if there is a correlation with any markers in the blood or diagnostic studies that can tell us how bad the infection is.  The studies can help us understand whether one needs surgery versus being able to treat with intravenous antibiotics.  Usually, x-rays or an MRI or bone scan will tell us where the infection is to the extent of how far deep into the foot or up the leg the infection goes.  There have been studies as to what markers in the blood he can tell us the severity of the infection.  The first thing that we look at is one is white blood cell count as that is the primary marker to see if your body is fighting infection by producing white blood cells to fight the infection.  There are other studies such as ESR and CRP that can tell us the severity of the infection.

    Recently there has been published research into a marker in the blood called procalcitonin.  Procalcitonin is the peptide precursor of the hormone calcitonin.  It usually is elevated when there is an inflammatory stimulus from a bacterial infection.  A recent study that was published in the Journal of diabetes research showed that increased procalcitonin levels at the time of admission to the hospital were a high indicator of amputation.  This is a very important study for doctors and patients alike as when one presents with an infected diabetic foot amongst all the many tests that need to be performed procalcitonin levels are very useful in helping the doctor and the patient be able to predict the proper treatment.

    foot ulcer
    foot wound

    This new data helps us create a better treatment plan with diabetics that have infections in the foot.  Instead of waiting around for surgery or debridements, when this data is available more definitive treatment can be offered to the patient and prevent amputations.  No one ever wants an amputation but given the choice of amputating a toe versus the whole leg, it seems obvious that one would rather lose the toe.  With the information available from the procalcitonin test that can be the difference between losing the toe or leg.