Posts Tagged ‘Infected Wounds’

To Your Feet

A condensed overview of diabetc skin ulcers, cause and prevention

Spring Dyer, a licensed nurse from San Antonio, Texas, who specializes in wound care has seen it all when it comes to wounds. Most of the wounds that I see are secondary to a disease process. She says of her experience. I care for diabetic ulcers, pressure ulcers, post-surgical wounds even radiation injuries. While ulcerated and infected wounds can occur in all of these areas of injury and disease, Dyer finds that most of the chronic skin ulcers occur in her patients with diabetes, stating that, Half of my diabetic patients have difficult-to-heal wounds.

National statistics seem to confirm this. Nearly 21 million Americans live with the complications of diabetes. According to the National Institute of Health, 15% of these patients will develop a lower extremity ulcer during the course of their disease. These ulcers are not only inconvenient, painful, and financially burdensome, but they can also lead to foot or leg amputation. In fact, complicated, diabetic ulcers are the leading cause of lower extremity amputation in the United States.

What causes these wounds? Why won’t they heal? What’s new in the quest for healing?

Diabetics have two primary factors that cause ulcer, and then later exacerbate the ulcer, by slowing the healing process. These two factors are nerve damage (neuropathy) and low blood flow (peripheral vascular disease). The combinations of these two symptoms can lead to countless situations that invite and further diabetic ulcers.

Consider this scenario. Mrs. Jones, a diabetic for nine years, buys new walking shoes. They seem to fit well, so she decides to wear them to her granddaughter’s birthday picnic the next day. After wearing the shoes all day her numb feet feel fine, so she wears the same shoes the next day, and the next day, and the next. What Mrs. Jones does not notice is that she has developed two bright red blisters on the back of her heel. She does not notice the blisters because her diabetes has caused a loss of sensation, numbness in her feet.

By the time that Mrs. Jones finally notices the blisters, they are infected. Although her health care provider prescribes an antibiotic, the wound refuses to heal. Instead it worsens and begins to ulcerate. This is because of the low blood flow to Mrs. Jones? legs and feet. When the body is injured, the blood provides oxygen, protein, and nutrients that allow the wound to heal. If blood flow is low, healing is hindered.

With my left ankle resting on my right knee, I watched as Kimi debrided the wound, meticulously slicing and picking off all the dead flesh. I couldn’t feel it, but still it bothered me to watch. It was too strong a reminder of my own vulnerability.

Dry, cracked skin presents a particular challenge to the diabetic. When blood glucose is elevated, your body loses more fluid. And when your body loses more fluid, your skin becomes dry. Also nerve damage (neuropathy mentioned above) can decrease the amount that you sweat, which further decreases moisture to your skin.

Neuropathy can also create weakness and atrophy in foot muscles which can cause the foot to misalign, putting greater pressure on certain areas of the foot, thus creating pressure sores. Once again, these sores may go undetected because of loss of sensation in the foot.

In addition to dry skin, nerve damage, and low blood flow certain medications can also increase the likelihood of ulceration in a diabetic patient. Commonly used diabetic drugs, such as oral steroids and rosiglitazone have been shown to increase edema (swelling) in diabetic patients.

Edema narrows the arteries, lessening the blood flow to a wound. And, as we discussed above, this low blood flow inhibits the body?s ability to heal itself.

While treatment for diabetic ulcers improves with every new development, the most effective form of treatment still comes in the form of prevention. Diabetics who take responsibility for their own treatment have far fewer incidences of ulceration. Be proactive. In addition to seeing a health care provider on a regular basis, following a diabetic diet, and taking all prescribed medications?you should also maintain proper hygiene and skin health.

The National Diabetes Information Clearinghouse (NDIC) offers the following suggestions:

  • Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes
  • Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
  • If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes
  • File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.
  • Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
  • Always wear shoes or slippers to protect your feet from injuries.
  • Always wear socks or stockings to avoid blisters. Do not wear socks or knee-high stockings that are too tight below your knee.
  • Wear shoes that fit well. Shop for shoes at the end of the day when your feet are bigger. Break in shoes slowly. Wear them 1 to 2 hours each day for the first 1 to 2 weeks.
  • Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.

The type of shoe you wear is important. A protective shoe is the more appropriate choice. Avoid wearing flip-flops or open-toe sandal type shoes. Your health care provider may prescribe diabetic shoes to alleviate pressure sores that may be caused by irregularities in your foot.

Promising new treatments such as the use of silver products, Anodyne Therapy or an alkalizing skin spray called Miracle Mist Plus have shown promising results in the cure and prevention of diabetic ulcers. The skin spray is inexpensive and has received glowing reports from many diabetics. If you think you may be developing a sore or ulcer, ask your health care provider about which treatment is best for you.

You do not need to be a statistic. Maintain a proper diet, good communication with your physician, and proactive foot and skin care. Do what you can to ensure good skin and foot health. Your time is worth the effort. To your feet! Take control and keep your lifestyle as convenient and pain free as you want it to be