November 06, 2019
Diabetes, Your Feet and Wound Care
Chronic, slow and non-healing wounds are an increasing medical problem. Although these wounds can be associated with many disease states, wound development and delayed wound healing are very common in the diabetic population. Of the estimated 26 million people in the United States, 8% are diabetic and 25% of those individuals will develop a wound in their lifetime. Wounds and ulcers tend to be more difficult to treat in patients with diabetes. So, why do diabetics have such a difficult time with wounds?
Normal wound healing has four distinct phases:
1) hemostasis [stopping the bleeding]
2) inflammation [brings the blood to the area and along with it the “stuff” that promotes healing]
3) proliferation [laying down the foundation for skin and skin growth], and
4) remodeling [maturation and strengthening of the skin and scar tissue]
“Diabetics often get ‘stuck’ in the inflammation phase,” says John Tassone, DPM, podiatrist with Summit Medical Group Arizona. “This prevents the wound from going to the critical proliferative phase and thus healing is stagnated. In the inflammatory phase, the wound will have some redness and swelling around it, which can mimic infection leading to the use of unnecessary antibiotics. This can disturb the normal bacteria which are present on our skin and help protect us. It can also lead to antibiotic-resistant 'superbugs' that can be very difficult to treat.”
Diabetics are prone to circulation issues. When blood flow is compromised, tissue, such as skin, dies. This also makes the diabetic prone to a diminished capacity to handle pressure on the skin. Pinched blood vessels that are already abnormal, will be further damaged with pressure. Thus, the old saying “it’s not only what you put on the wound that matters, but it’s also what you take off the wound (i.e. pressure)”. Additionally, when the blood sugar is elevated immune cells that are responsible for healing and fighting infection may not work optimally. Finally, the high blood glucose leads to what is called glycosylation, the binding of excess sugar molecules to tissue, such as skin. This leads to decreased elasticity and weaker skin.
Long-term high sugars can also lead to poor nerve function and reduced sensitivity of the feet. A small injury may not be noticed until it becomes a bigger problem.
Given these risks, it is vital that individuals with diabetes pay close attention to their skin and focus on wound prevention and early care when wounds develop.
Tips on protecting your feet:
• Always wear shoes and cotton socks.
• Check your shoes for pebbles or other debris before putting your feet in.
• Inspect your feet daily (including between your toes and if you can’t see the bottoms of your feet, use a mirror).
• Dry your feet thoroughly after bathing to ensure there is no moisture between the toes.
• If a wound develops, wash it with soap and water, and keep it clear.
• Seek medical care to develop a plan for proper care. Self- care should only be utilized until you can see a medical professional.