Diabetic Feet: Complications & 8 Steps to Wound Prevention

    
Kiah Connolly, MD

Why does everyone seem to be so paranoid about protecting feet? 

Wounds in people with diabetes can literally be deadly. And while wounds can happen anywhere, they are frequently found on feet. Diabetic wounds have a harder time healing and are more likely to become infected. 

Causes of Diabetic Wounds 

People with poorly controlled diabetes have a perfect storm for developing chronic and complicated wounds.

Factors that Contribute to Diabetic Wounds:

  • Decreased Sensation due to Peripheral Neuropathy (can’t feel injuries occurring) 
  • Poor Circulation (decreased blood flow)
  • Impaired Wound Healing (high blood glucose impairs wound healing) 
  • Increased Risk of Infections (diabetics are immunocompromised

Decreased Sensation

Many people with diabetes have decreased sensation to their feet, a condition called neuropathy. Diabetic neuropathy makes it easier for people to develop wounds as it limits their awareness of injuries as they occur. This is true for mild traumatic injuries (ie: stubbing a toe, cuts, scrapes) as well as for more long term injuries (ie: blisters while wearing shoes). 

Because people with diabetes may not be able to feel injuries on their feet as they happen, the injuries are more likely to be more severe and become progressively worse over time. 

 

Poor Circulation

People with diabetes are also at an increased risk of having problems with their blood vessels (atherosclerosis) that can cause them to have poor circulation.

Without adequate blood flow, there is not enough nutrients and oxygen circulating to the wound for optimal healing conditions. 

Impaired Wound Healing & Increased Risk of Infections

High blood sugars in people with diabetes limits how well the immune system can work and how well the body can heal. In fact, people with diabetes are thought of as being ‘immunosuppressed’. 

Because diabetes compromises the immune system, these infections are more likely to occur and also harder to get rid of. Both the poor circulation and impaired immune system makes the wound harder to heal. 

Bottom line: It’s easier for people with diabetes to sustain injuries and it’s harder for these injuries to heal. People with diabetes are also more likely to get infections, and they have a harder time fighting off these infections. 

Diabetes Amputations

Unfortunately, wounds commonly get out of control. Sometimes diabetic wounds keep getting worse despite aggressive wound care and antibiotics.

Even a simple diabetic foot ulcer can keep getting deeper until it reaches bone - and becomes a dangerous condition called osteomyelitis (bone infection). The infection can also get into the bloodstream - another dangerous condition called bacteremia (blood infection).  

If wound care and antibiotics aren’t working for these conditions, the last remaining option is to cut off the body part that is the source of the infection (amputation). 

Amputations are used as a last resort - but they can be life-saving in these severe cases. 

Diabetic Foot Care 

There are some basic wound care principles that all diabetics can follow. 

1. Perform Daily Self Exams of Your Own Feet 

Take a close look at your legs and feet daily. 

Examine each toe, the web spaces in between each toe and the bottom of both feet for any signs of corns and calluses, ingrown toenails, cuts or scratches, blisters, bruising or ulcers. 

Tips: Using a mirror can be helpful for some people who find it difficult to examine their own toes. A family member, significant other or friend can also help with a foot exam. 

Checking your feet should become a daily routine.

Many large wounds can start out with very small injuries - such as a stubbed toe, or a small scratch. Prevention is key. However, if you do have even a small injury starting wound care early can prevent it from developing into a devastating wound in the future.

2. Prevent Injuries 

Avoid activities that place you at risk of injuring your feet. Because many people with diabetes can’t feel their feet well, they are at an increased risk for injuries including burns. It’s therefore important to take basic cautions during daily activities such as making sure the bathwater isn’t too hot and avoid placing heating pads directly on the feet. 

Be cautious when cutting your toenails to make sure you don’t injure yourself and make sure you don’t cut nails too close to the cuticle to avoid ingrown toenails. 

Avoid going barefoot. This includes wearing socks, even in the house, in order to prevent small scratches. Wearing well-fitting shoes offers even more protection.

3. Wear Diabetic Shoes

An excellent way to both prevent and care for wounds is to utilize diabetic shoes. These offer additional protection and support to help prevent even the smallest injuries.

4. Control Your Blood Sugar Levels 

Core to caring for your feet includes glucose control. Check your sugars regularly and working with your doctor to manage your medications, diet, and exercise to ensure your glucose is kept in check.

5. Keep Your Feet Clean and Dry

Keeping feet clean with soap and water at least once daily is part of basic foot care. Drying your feet thoroughly is also important prior to protecting them with socks and shoes.

6. Take Your Medications as Prescribed 

Taking your diabetes medications as prescribed is critical for controlling your blood sugars. If your wound becomes infected, your doctor may prescribe you antibiotics. It’s important to finish the whole course of antibiotics to make sure the infection goes away - even if it seems better before you’ve finished taking all of the medication.

7. Go to Regular Doctor Checkups

It’s generally recommended that all diabetics have their feet examined either by their primary care physician or podiatrist (foot doctor) at least once yearly as part of their annual check-up. This allows your health care provider to evaluate any problems you may have with circulation, nerve damage, deformities, and injuries. 

These visits will need to be much more frequent if you have a wound. Diabetic wound care can be complex and vary between individuals and their wounds. Complex wounds often require a wound care specialist for close management.

8. Quit Smoking 

Yes, smoking is even bad for our feet! It causes problems with our heart and vessels that lead to decreased blood flow to our feet that then contributes to poor wound healing.

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