Diabetic Leg Wounds

June 12, 2024

Today I saw someone painfully hobbling out of the surgery towards a car, their leg heavily bandaged; I went to open the car door for their helper and we ended up having a short conversation. He was an elderly neighbour with no family support and had been suffering with diabetes.

Diabetes can hit us as we age and brings with it a number of conditions, including leg ulcers and foot ulcers. The main contributing factors include peripheral neuropathy, peripheral artery disease (PAD), and immune system impairments. Here’s a detailed look at how these factors lead to the development of leg ulcers in diabetic individuals:

1. Peripheral Neuropathy:

  • Nerve Damage: Diabetes can cause damage to peripheral nerves, especially in the legs and feet. This condition, known as peripheral neuropathy, reduces sensation in the affected areas.
  • Lack of Sensation: Reduced sensation means that minor injuries or pressure points can go unnoticed, allowing them to worsen without the individual being aware. This can lead to the development of sores and ulcers.
  • Poor Healing Awareness: Without the ability to feel pain properly, diabetics may not recognize the severity of wounds, delaying treatment and exacerbating the issue.

2. Peripheral Artery Disease (PAD):

  • Reduced Blood Flow: Diabetes often leads to atherosclerosis, a condition where arteries become narrowed and hardened due to plaque buildup. This can reduce blood flow to the legs and feet.
  • Impaired Wound Healing: Adequate blood flow is essential for delivering oxygen and nutrients necessary for tissue repair. Reduced blood flow slows down the healing process, making ulcers more likely to form and persist.

3. Immune System Impairment:

  • Weakened Immune Response: Diabetes can impair the immune system, reducing the body’s ability to fight infections. This makes diabetics more susceptible to infections that can complicate and worsen ulcers.
  • Chronic Inflammation: Persistent high blood sugar levels can cause chronic inflammation, which further impairs the healing process and increases the risk of ulcers becoming infected.

4. Other Contributing Factors:

  • Foot Deformities: Diabetes can lead to changes in foot shape due to nerve damage and poor muscle control. These deformities can create areas of high pressure that are prone to ulceration.
  • Calluses and Corns: The presence of calluses and corns can increase pressure on certain areas of the foot, leading to skin breakdown and ulcer formation.
  • Dry Skin: Diabetes can cause autonomic neuropathy, which affects the nerves controlling sweat and oil production in the skin. This can lead to dry, cracked skin that is more susceptible to ulcers.

Prevention and Management:

To prevent and manage leg ulcers in diabetics, the following steps are crucial:

  1. Blood Sugar Control:
    • Monitoring: Regularly monitor blood sugar levels to keep them within the target range.
    • Medication: Adhere to prescribed diabetes medications or insulin therapy.
  2. Foot Care:
    • Daily Inspections: Inspect feet daily for cuts, blisters, redness, or swelling.
    • Proper Footwear: Wear well-fitting shoes that protect the feet and reduce pressure points.
    • Regular Podiatrist Visits: See a podiatrist regularly for professional foot care and advice.
  3. Wound Care:
    • Prompt Treatment: Treat any cuts or blisters immediately to prevent them from developing into ulcers.
    • Professional Wound Care: Seek professional help for wound care to ensure proper cleaning, dressing, and monitoring of ulcers.
  4. Lifestyle Modifications:
    • Smoking Cessation: Quit smoking to improve circulation and overall health.
    • Healthy Diet: Maintain a balanced diet to support overall health and blood sugar control.
    • Regular Exercise: Engage in regular physical activity to improve circulation and overall health, while ensuring it is safe and does not injure the feet.
  5. Managing Complications:
    • Regular Health Checkups: Regularly see a healthcare provider to manage diabetes and monitor for complications like PAD and neuropathy.
    • Compression Therapy: Use compression stockings if recommended by a healthcare provider to improve circulation.

By understanding the causes and taking proactive steps, diabetics can significantly reduce the risk of developing leg ulcers and manage them effectively if they do occur. If you or anyone you know is affected, please speak with your doctor.

You may also like to check out the work of Prof Roy Taylor at Newcastle University who has done a lot of work into helping diabetics improve their diabetes via the foods they eat.

 

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