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Lower Extremity Infections: Your History

Information is our ally and so when you feel that you may have an infection of the foot, ankle, and leg, prepare yourself for the following questions. Having the answers to these questions will assist the physician in determining the best course of treatment. The following is the order in which most physicians address the new patient encounter when it comes to an infection.

Use Caution!

History of chief complaint – When you go to the doctor, he or she works off the basis of your chief complaint. This is the reason you’re going to the doctor. Many times we have multiple complaints or issues. It helps when we prioritize these issues in order to make sure the most important concern is addressed.
o When did the infection begin?
o Where and how was it acquired? The doctor will distinguish between community and nosocomial (hospital- acquired) infections. If your wound is from a surgical wound, how long after the procedure did the first signs develop?

• Past treatment
o What previous treatment, if any, have you received? If you have been taking antibiotics prescribed for this or any other condition, which antibiotic and how much is left?
• Drug allergies/sensitivities – it is important to know which, if any, of the many drugs that a provider might prescribe you are allergic to.
o Do you have an allergy to penicillin or another antimicrobial agent?
o What form did the allergy take? It is also important to be able to describe what reaction you had to the drug. Did you have an itchy rash, throat swelling, hives, or low blood pressure?
o How long ago did it occur and with what drug?
• Review of systems
o We will inquire about the presence of fever, chills, nausea, vomiting, diarrhea, weakness, a general discomfort or uneasiness, and diaphoresis (the medical term for profuse sweating or perspiring). These are called systemic signs of infection, or signs that the infection is affecting the entire body.
• Past Medical history
o You should include any history diabetes, human immunodeficiency virus (HIV), tuberculosis, sexually transmitted diseases, sickle cell anemia, kidney or liver disease, and risk factors for infective endocarditis (IE) (including artificial heart valves, heart defects you were born with, a history of endocarditis, or a history of using intravenous (IV) illegal drugs).
• Past surgical history – If you recently had foot or ankle surgery, the surgeon you are following up with knows this and will be aware of the signs of infection. In addition to this information, if you are at another doctor’s office, or in the emergency room, the following will be important information to share.
o Do you have implanted biomaterials, prosthetic joints, heart valves, or shunts that might become infected through the blood stream if the infection gets bad enough?
Have you recently been hospitalized, putting you at risk for methicillin resistant Staphylococcus aureus (MRSA), or have you had a previous MRSA infection? There are differences in the community acquired and hospital acquired MRSA strains which lead to antibiotic resistance. Having knowledge of which setting the infection came from directs the choice of antibiotic used.
• Social history – Helping the physician understand where you have been, what you do for work and if you have pets in the home will assist in developing the origin of the infection

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McGlamry’s Comprehensive Textbook of Foot an Ankle Surgery, 4th edition. Lippincott Williams & Wilkins. 2013