Leg cellulitis and how a podiatrist can help

There are numerous reasons why a person may develop an infection to the leg, also called cellulitis. Some are obvious, such as drug injections using contaminated (dirty) instruments. While others are not so clear. 

  Left: initial presentation in the office. Right: 3 weeks after antibiotic treatment.

Left: initial presentation in the office. Right: 3 weeks after antibiotic treatment.

Here is an example of a patient I have been seeing for a long time because of multiple wound issues. The most recent problem he presented with is the development of a leg infection. He can only recall that he bumped the ankle against some furniture at home. He then developed general weakness and the leg became very red, swollen with clear draining fluid throughout. He came to see me in the office and I immediately sent him to the hospital for further medical management. 

With the help of the hospitalist and infectious diseases doctors, the infection was able to be controlled and eventually resolved. What I do as a podiatrist is assess the patient's condition and determine the urgency that is needed for hospital care. Then, I provide recommendations for wound care and continue to see the patient in the wound clinic, monitoring the progression. With that amount of swelling, seen in the picture, compression wraps are very helpful. Because I see the patient so frequently, he knows I'm only a phone call or text away to help him. 

Does everyone who gets a scratch on their skin get cellulitis? No, but some patients who are immune compromised or have a history of wounds and infections require a lot more medical attention, which I am attentive to. This particular patient has a baseline lymphedema (chronic leg swelling) that can be misinterpreted as a cellulitis. It requires a well-trained wound specialist who knows the patient well to determine what is their normal and what is not normal. 

Often times I see very "normal" leg redness from chronic lymphedema that is not cellulitis, while other times cellulitis gets overlooked or is mismanaged. A podiatrist well versed in wound care should be part of a medical team to help determine whether changes in the patient's legs are normal or unusual. A team effort helps patients heal faster.