Nursing Continue Education

Cellulitis + Diabetes Foot Care Guidelines (Reading & Sharing)

Cellulitis -a diffuse inflammation of the deep dermal and subcutaneous tissue that results from an infectious process.

Cellulitis caused by infection with group A beta-hemolytic streptococci, Staphylocossus aureus, Haemophilus influenzae, or other organisms, usually results from break in skin that may be as simple as athlete’s foot, and infection can spread rapidly through lymphatic system. As according to Raff and Kroshinsky (2016), cellulitis is a common global health burden, with more than 650,000 admissions per year in the United States alone. Raff and Kroshinsky further explained that in the U.S., an estimate 14.5 million cases annually of cellulitis about for $3.7 billion in ambulatory care costs alone. About 88% of cellulitis occurs in the lower limb (Njim, Aminde, Agbor, Toukam, Kashaf, & Ohuma, 2017).

The patient has signs of infection to the affected area, which is swollen, warm, red, and tender, as well as tender, warm, erythematous streak that extends proximally from the area, in which indicating lymph vessel involvement. Patient may also have fluctuant abscess or purulent drainage, and possible fever, chills, headache, and malaise.

Diagnostic Evaluation

Cellulitis is diagnosed by physical examination. Laboratory testing and x-rays are not required. However, with more severe skin infections, studies like CT scans and ultrasound might be done to look for deeper pockets of infection, such as abscesses (Linder and Malani, 2017). Other diagnostic tests are:

  • Gram stain and culture of drainage
  • Blood cultures

Treatment Management

  • Oral antibiotics, surch as penicillinase-resistant penicillins, cephalosporins, quinolones, or sulfa-based, may be adequate to treat small, localized areas of cellulitis of legs or trunk.
  • Parenteral antibiotics may be needed for cellulitis of the hands, face, or lymphatic or widespread involvement
  • Surgical drainage and debridement for suppurative areas, especially recommended for MRSA infections

Linder, K. A., & Malani, P. N. (2017). Cellulitis. Jama, 317(20), 2142. doi:10.1001/jama.2017.5205

Njim, T., Aminde, L. N., Agbor, V. N., Toukam, L. D., Kashaf, S. S., & Ohuma, E. O. (2017). Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study. BMC Infectious Diseases, 17(1), 418. doi:10.1186/s12879-017-2519

Raff, A. B., & Kroshinsky, D. (2016). Cellulitis: A Review. Jama, 316(3), 325-337. doi:10.1001/jama.2016.8825


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Diabetes Foot Care Guidelines

***Retrieved from https://www.foothealthfacts.org/conditions/diabetic-foot-care-guidelines

  • Inspect your feet daily. Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything.
  • Bathe feet in lukewarm, never hot, water. Keep your feet clean by washing them daily. Use only lukewarm water—the temperature you would use on a newborn baby.
  • Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.
  • Moisturize your feet but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes—that could encourage a fungal infection.
  • Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor.
  • Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.
  • Wear clean, dry socks. Change them daily.
  • Consider socks made specifically for patients living with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin.
  • Wear socks to bed. If your feet get cold at night, wear socks. Never use a heating pad or a hot water bottle.
  • Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.
  • Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter.
  • Consider using an antiperspirant on the soles of your feet. This is helpful if you have excessive sweating of the feet.
  • Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut.
  • Take care of your diabetes. Keep your blood sugar levels under control.
  • Do not smoke. Smoking restricts blood flow in your feet.
  • Get periodic foot exams. Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.


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