Simplifying Wound Care and Prevention

The vast majority of foot wounds are preventable and there are lots of ways to lower your risk, ranging from the simple to the high-tech. Some include:

  • See your doctors regularly. Your podiatrist can determine your appropriate risk category.

  • Get a quality pair of shoes, and be sure they are properly sized.

  • The American Podiatric Medical Association tells patients to “knock their socks off.” Inspect your feet every day. You’re looking for something different, like swelling, redness or a little blood in your sock.

  • If you notice a change, get in to see your podiatrist immediately. Often it’s a little problem. I’d much rather see you for a little problem than a big problem—even if it is a false alarm.

If you do develop a wound, it can be treated. We can remove non-viable tissue and relieve pressure to keep you walking. Technologies can kick-start healing. We can use specialized skin grafts to close wounds. There’s a lot of next-gen “Star Trek” stuff happening.

Once healed, there are many promising wearables being developed—from smart socks to smart insoles to smart appliances—that can identify problems in the home. It really is an exciting time in prevention.

Working with your podiatrist, you can marry low-tech and high-tech to focus on prevention, as well as next-generation cures.

By David G. Armstrong, DPM, M.D., Ph.D., Cofounder and Director, Southern Arizona Limb Salvage Alliance, Professor of Surgery, University of Arizona

Many people are familiar with some of the more well-known consequences of having diabetes: the need for oral medications or insulin injections, managing one’s eating habits and the potential for heart-related complications.

Related to these, but far less understood, is the difficulty of managing skin care generally and wound care, specifically.

The debrief

Diabetes is the inability of the body to produce enough of the hormone insulin needed for the muscles to absorb sugar from the blood stream. Type 1 diabetes is an autoimmune disorder in which the pancreas, which produces insulin, is attacked by the body. Type 2 diabetes is often the inability to use insulin rather than a problem of producing insulin. This leads to metabolic syndrome, a cluster of health factors that includes high blood pressure, high blood sugar, high cholesterol levels and obesity.

High blood sugar levels will cause the blood to be "thick, and sticky." High cholesterol and or high triglycerides are blood fats that cause the blood to become "greasy." And high blood pressure will damage the interior walls of the arteries, leaving them vulnerable to the build up plaque, which can block the blood flow.

To the surface

What does all of this have to do with skin care? A lot. If these conditions exist, they will affect the capillaries, very small blood vessels that reach and nourish the skin. If they are damaged, the skin will not receive the oxygen and other nutrients that it needs to thrive and to heal. White blood cells needed to fight infection will have difficulty reaching the wound. The high percentage of people in wound care centers who have diabetes is testament to this dynamic.

And, as the feet are the furthest from the heart, many people with diabetes often deal with poor circulation to the feet leading to foot care issues, and some are even subject to amputation.

What can a person with diabetes do to against skin breakdown in the foot? For prevention of foot ulcers and other damage:

  • Inspect feet daily. Check for cuts, bruises, sores, or changes to the toenails, such as thickening or discoloration.

  • Wear thick, soft socks that do not have seams.

  • Exercise daily with a supportive athletic shoe.

  • Have new shoes properly measured and fitted.

  • Don't go barefoot.

  • Never try to remove calluses, corns or warts by yourself.

  • Keep your feet hydrated with a foot cream, particularly during the winter months.

  • Keep blood sugar, blood pressure and cholesterol under good control.

  • Do not smoke, as this adds tar and nicotine that also clogs arteries.

  • Careful manicuring to avoid any injury that would be difficult to heal.

  • Get good nutrition.

  • See a podiatrist regularly.

If you develop a foot ulcer:

  • Understand you are not alone. It is estimated that 25-33 percent of all money spent on caring for people with diabetes in the U.S. is related to a foot ulcer.

  • Consult a health care provider as soon as possible even for minor injuries to the feet. Often the longer a wound goes untreated, the harder it is to treat.

  • Recognize that foot ulcers may take a while to heal (on average four months).

  • Find a wound care center (or provider) near you that works closely with a multidisciplinary team to provide comprehensive wound care. The team may include a podiatrist, vascular surgeon, diabetes educator, physical therapist, pedorthist, infectious disease doctor and orthopedist, among others.

And most importantly, see a diabetes educator. Diabetes educators are trained health care professionals who teach people with diabetes how to manage their disease and prevent complications. To find a diabetes educator, visit www.diabeteseducator.org.