cellulitisCellulitis occurs when one or more types of bacteria enter through a crack or break in the skin. Sometimes the break in the skin is obvious, such as a scratch, cut or an incision from a surgical procedure. It is the number one sign of bacterial infection. In the foot, other sources of breaks in the skin include heel fissure, ulcers and burns. Other times the source can be deceiving such as secondary to an insect bite or secondary to an eczema or rash. This is certainly true of athletes foot. A secondary bacterial infection is very common with athletes foot which is one of the reasons that even if you have a mild case of athletes foot it should be treated to prevent a worsening and possible cellulitis. Even dry flaky skin or swollen skin are potential sites for cellulitis to develop. It is also possible to have a cellulitis with no break in the skin; such is the case with thrombophlebitis. For reasons just stated, cellulitis therefore is very common in the foot and lower leg. Cellulitis is caused by bacteria, generally streptococcus or staphylococcus, but there can be other bacteria mixed in. This is especially true in diabetics People whose immune systems are weakened for any reason (including from chemotherapy for cancer or other immune-suppressing drugs) and those with diabetes or AIDS are at highest risk for developing cellulitis. Cellulitis usually presents itself as swelling, redness and tenderness at the site of infection. Additionally a person may also have fever, chills and swollen lymph nodes, which is usually seen in advancing cellulitis. In more severe cases untreated cellulitis can get into the blood stream leading to systemic manifestations. Locally, the soft tissue infection may invade adjacent bone resulting in osteomyelitis. Below is a picture of cellulitis in the foot.
To further complicate matters, not all redness in the foot is from cellulitis. A superficial phlebitis, a foot fracture, tendonitis, gout, and local trauma to the foot call all cause redness and pain. Treatment is predicated on the severity of the cellulitis. In most cases an oral antibiotic is prescribed. The key here is to take all of the antibiotics no matter how good the foot may look after a day or so. Typically, what happens is that the infection begins to look and feel much better in a couple of days and the patient will stop taking the antibiotics only to experience what is known as a rebound phenomenon where the cellulitis and infection return, thus delaying the time it takes to ultimately clear up the problem. Locally, the affected area will also be treated with topical medication and a dressing to prevent re-infection. If there is an underlying cause for the cellulitis such as chronic athletes foot, fissuring, dryness in the skin or foot ulcers, they all have to be addressed otherwise the risk of re-infection remains high. Unfortunately, simple cellulitis that is improperly treated many times will turn into a severe infection. Depending on the overall health status of the patient, bedrest, intravenous antibiotics and possibly hospitalization may all be necessary.
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