Good advice and the latest advances to help you keep little cuts from becoming big problems.
For most people, a minor cut or blister is a nuisance. But if you have diabetes, small wounds can quickly morph into something serious. According to the Journal of the American Medical Association, one in four people with diabetes will develop a wound that turns into an ulceran open sore. More than half of those ulcers will become infected, and one-fifth of infected ulcers will lead to an amputation. Fortunately, being scrupulous about your skin and foot health can go a long way toward preventing wounds and helping them heal properly.
Why wounds happen
Even people with well-controlled diabetes are more likely to develop wounds, most of which occur on the ankles and feet. The skin in these areas often becomes dry and cracked, making it more vulnerable to infection. Nerve damage (also called neuropathy)a common diabetes complicationcan contribute by causing numbness and lack of feeling in the feet.
"Pain is a warning sign, but if you have significant nerve damage, you can't feel the pain, so you don't get the warning, says Lee C. Rogers, D.P.M., co-medical director of the amputation prevention center at Valley Presbyterian Hospital in Los Angeles. "So you may have a pebble in your shoe, and you will continue to walk on it and be completely unaware that a callus or blister is forming."
Wounds also take longer to heal if you have diabetes, says Raul J. Guzman, M.D., head of the vascular clinic at Boston's Joslin Diabetes Center. Why? Swelling and vascular problems (such as peripheral arterial disease) in the lower limbs inhibit healing, while high blood sugar can impair your immune system.
Know how to treat your feet
Basic preventive measures can make all the difference in keeping cuts and blisters at bay. Always check the insides of your shoes for pebbles or other items before you put them on, wear socks with well-fitting shoes and never go barefoot, says Lisa Foster-McNulty, M.S.N., R.N., C.D.E., a nurse with Integrated Diabetes Services in Wynnewood, PA.
Keep your feet moisturized, because dry skin can split and become a portal for germs. "For folks with diabetic neuropathy, the texture of the skin on the feet changes from that of a tortilla to that of a cracker over time," says David G. Armstrong, D.P.M., M.D., Ph.D., director of the Southern Arizona Limb Salvage Alliance (SALSA) at the University of Arizona in Tucson. Hydrate your feet with a rich over-the-counter foot cream; if necessary, your doctor can prescribe a medicated type. Skip the naturally moist area between your toes, because too much moisture can lead to fungal infections.
Daily inspections are also critical (use a mirror if you can't see the bottom of your feet). Notice how your feet look when they're healthy, so that any sore spots are instantly obvious. "If you see anything different, call your podiatrist immediately," says Foster-McNulty. "Watching and waiting is never a good strategy with a wound, especially if you have neuropathy or poor circulation."
Err on the side of caution
If your diabetes is well-controlled, your doctor may advise you to treat small cuts by washing the area with soap and water and applying an antibiotic ointment and bandage at home. Sometimes, however, the actual break in the skin can be small, with a larger ulcer hiding from view under the surrounding skin. If your wound needs professional attention, the first step will be for a doctor to remove dead or infected tissuea process known as debriding. This can be done surgically, with scalpels and other instruments, or with topical enzyme treatments.
A study in the Archives of Dermatology found that applying medical-grade maggots to open wounds is an effective age-old debriding technique (for patients who can stand the ick factor); local or general anesthesia may be necessary, depending on how serious your wound is and the complexity of the procedure required.
Let the Healing Begin
After it's been cleaned, your wound will be dressed and kept moist. "The old thinking was to let air get at it and let a scab form, but that is now believed to be harmful," says Foster-McNulty. "Wounds and ulcers heal faster, with a lower risk of infection, if they are kept moist and covered."
Substances used in dressings include saline, collagen, silver and growth factors derived from human skin cells. You may be asked to wear a total contact cast, which redistributes weight to the areas of your legs that aren't affected by the ulcer, and you'll be prescribed an oral antibiotic. How soon a wound heals depends on its severity, your overall healthand how carefully you follow your doctor's instructions.
From our sister publication Diabetes Focus Winter 2013