Back in June, the Columbus Dispatch published an article on the scary reality of sepsis or septicemia, an infection of the blood that can be deadly. This past week a follow up article was run on the positive outlook of the Columbus man who survived his sepsis and subsequent below the knee amputation. With the help of a new prosthetic leg, the man is learning to walk again.
While sepsis is a terrifying infection of the blood, an often related infection that frequently occurs in the foot and leg is called “osteomyelitis”. Osteomyelitis occurs when bacteria reaches and infects the bone. As bone tries to fight off the infection, it often walls off the dead piece of bone, called a sequestrum, and attempts to envelop the piece away from healthy tissue by quickly synthesizing a weaker woven bone around it called an involucrum. Pain that feels as though it is coming from the bone, and edema, or swelling are the most common initial complaints of a patient with osteomyelitis. In order to diagnose a bone infection, taking x-rays are the first step. A timely diagnosis is imperative to prevent the spread of infection through larger areas of the bone and into the joint. If not caught early enough, like sepsis, osteomyelitis may require lower extremity amputation to prevent further damage.
But how can bacteria get to your bones through the surrounding layers of skin, fat and muscle unless you have had a bad fracture where the bone penetrated the skin? In children, an elevated amount of bacteria in the bloodstream can not only lead to sepsis, but also has a tendency to dwell in and infect the slow moving capillaries of still growing bones. This is called hematogenous osteomyelitis in which the blood has carried the igniting agent for the bone infection. In adults, “direct extension” osteomyelitis is the most common cause of bone infections, with the foot bones of diabetic patients being at a very high risk. Direct extension means that bacteria has infected a wound in the more superficial tissues, such as the skin or fat and then “extended” its way down to attack the bone. Because many diabetic patients often have lost some or all of their sensation in their feet, a small cut or irritation can quickly develop into a major ulcer by the individual unknowingly continuing to irritate the sensationless area. This injury then allows an easy route for bacteria to travel to and attack the bones of the foot. Amputation is a serious risk in diabetic patients through this process.
Amputation is a grave condition on its own for diabetic patients. Within five years of one below the knee amputation, research has shown that risk of below the knee amputation of the other leg greatly increased. The second amputation has an almost deadly effect, with increased mortality seen within the next five years. It is for these reasons that even the smallest wound or ulcer of the foot or ankle must be taken very seriously by diabetic patients. Regular self-exams and visits to your podiatrist at the first sign of injury, infection or bone pain in any patient are critical to preventing and treating these deadly conditions.
Please visit www.ColumbusFoot.com for more information or call 614-885 FEET (3338) to schedule an appointment with a podiatrist in Columbus, Ohio. Columbus Podiatry & Surgery is located on the North side of Columbus, Ohio near Worthington.