Why are foot sores so dangerous for people with diabetes?
The anatomy of the foot already makes foot sores a strong possibility.
“The foot is a complex part of the body, and many important structures—bone, tendon, muscle, joint—are close to the skin surface,” explains Kent Marcuson, M.D., medical director at Sentara Wound Healing Center in Williamsburg.
That’s why what starts as a simple foot sore could lead to an amputation more easily than with other areas of the body — especially if you have diabetes.
Yes, an amputation is the worst-case scenario, but that doesn’t mean it isn’t realistic.
If you have diabetes, you’re especially at risk for foot sores. But knowing why that is and how to take care of your feet can help you avoid that worst-case scenario.
The Downward Spiral of Foot Sores
“Patients with long-standing diabetes frequently develop neuropathy, which causes a decreased sensitivity in the nerves that supply the feet,” Dr. Marcuson explains. “This means the patient is less likely to feel an injury to the foot.”
In a person without diabetes, healing is usually brisk and white blood cells are efficient in killing off bacteria that contaminate the wound. But in a person with diabetes, “elevated blood sugars slow down the normal healing rates of injured tissue and impair the ability for white blood cells to kill bacteria,” Dr. Marcuson says.
“And there are frequently microscopic reductions in blood flow to tissue that decrease oxygen supply and the supply of immune cells to the injured tissue.”
When this happens, foot sores can fester and become infected, usually because the person doesn’t seek treatment in time. “Sores on the feet are more difficult for the patient to see and evaluate well,” Dr. Marcuson says, “and continued walking on an open wound will further damage injured tissue from repeated pressure. That will slow down wound healing.”
All of these factors together diminish the person’s quality of life. “Physical activity is often limited. Time off from work is commonly required,” Dr. Marcuson explains. “Custom footwear is usually required to offload the area where the wound is located.”
The problem with restricting physical activity is that exercise is one of the best tactics for managing diabetes. Without physical activity, blood sugar levels can rise. Then, there’s the financial burden of having to take time off work and spend money on custom shoes.
This is all on top of the constant blood sugar checks, insulin injections, and doctor’s appointments that can already make life with diabetes complicated.
How Are Foot Sores Treated?
Treatment can be different for each person, but Dr. Marcuson says there are some common approaches:
- IV antibiotics
- Ensuring adequate blood flow. This can sometimes require invasive procedures to open arteries supplying the leg and foot.
- Using bioengineered tissues to stimulate wound healing.
- Changing of medical regimen to control blood sugar
“Some diabetic foot infections are good candidates for adjunctive hyperbaric medicine and we provide that treatment as well,” Dr. Marcuson says.
Hyperbaric treatment involves Hyperbaric treatment involves exposing the patient to a higher-than-normal level of air pressure and a higher than normal concentration of inspired oxygen, explains the National Institutes of Health. With this procedure, your blood can carry more oxygen to your wound to help it heal.
How Can You Take Care of Your Feet to Prevent Foot Sores?
The American Diabetes Association offers these 7 tips for taking care of your feet:
- Check your feet for red spots, cuts, swelling, and blisters every day. Use a mirror if you can’t see the bottom of your feet.
- Wash and dry your feet every day.
- Keep your skin soft by applying lotion everywhere except between your toes.
- Keep your toenails trimmed and filed.
- Avoid going barefoot. Always wear shoes and socks.
- Protect your feet from extreme heat and cold.
- Keep the circulation to your foot moving by wiggling your toes and moving your ankles up and down. Avoid crossing your legs for extended periods of time.