Cellulitis or Lower Extremity Infection

Diagnosis/Definition

• An infected lower extremity is described as any signs or symptoms of infection of the leg, ankle, or foot with or without the presence of a wound.

Initial Diagnosis and Management

Lower extremity infections not responding to standard therapy as anticipated and/or complicated by one or more of the following conditions: 

1. Signs and symptoms of infection (red; hot; swollen; painful area)
2. Presence of deep space abscess (frank pus from wound; tense, swollen area; flocculence)
3. Unresponsive to current antibiotic treatment
4. Neuropathy
5. History of foreign body
6. Diabetes
7. History of amputation (partial foot or partial lower extremity)
8. History of osteomyelitis or exposed bone, ligament, joint structures
9. History of neuromuscular disease processes’, autoimmune processes’ (rheumatoid arthritis, scleroderma)
10. Foot deformity
11. End stage renal disease
12. Compromised skin integrity
13. Compromised nutritional status
14. Deep vein thrombosis (DVT)
15. Vascular compromise (thin shiny skin; edema; varicose veins, etc.)
16. Disability affecting normal lower extremity movement or function

History of Charcot foot (see CHARCOT FOOT REFERRAL GUIDELINE)
Acute Treatment:

• In addition to properly cleaning the wound and extremity, the following should be considered:
• Antibiotic therapy
• Weight bearing x-ray of both feet/ankles (if foreign body non-weight bearing x-ray) should beobtained with MRI if indicated
• ASAP consult to the Limb Preservation Service.

Ongoing Management and Objectives  

• To decrease the rate of lower extremity infections.
• To decrease the rate of toe, foot and lower extremity amputation with prompt referral of active infection with or without ulceration/wounds.
• To manage each patient’s condition with a combination of mechanical, medical and surgical therapies tailored specifically for the unique characteristics of the infection being treated.

Indications for Specialty Care Referral

• All patients with lower extremity infections not responding to standard therapy and or complicated by morbidity should be referred for evaluation to the Wound and Ostomy Clinic as an ASAP consult. All patients will require an approved consul to be seen.

Criteria for Return to Primary Care

• All patients should be followed by the primary care provider for treatment of all co-morbid conditions and routine care with the goal of optimal health and wellness for the whole patient.