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Published on January 25, 2022

If you have diabetes, you are at greater risk for this

Diabetes Wound

A blister or callus on your foot may not be serious to most people – but it can be to people with diabetes.

If you have diabetes, a seemingly minor skin irritation can turn into an ulcer that’s difficult to heal. In some cases, it may become so bad it requires amputation ranging from part of a toe to much of a leg.

That’s serious.

Patrick J. Flynn, MD, medical director of Cape Cod Healthcare’s two wound care centers in Bourne and Hyannis, puts the risk into perspective.

“Just over 30 percent of diabetics will develop an ulcer over their lifetime,” he said. “If you develop an ulcer, one in six requires an amputation.”

Amputation raises the risk of dying within five years by 50 percent, he continued.

“You’ve effectively affected your lifetime by letting these things get out of control,” Dr. Flynn said.

A Double Whammy

Diabetes raises wound risk and hinders wound healing. According to Dr. Flynn, too much sugar in your body, a condition called hyperglycemia, damages nerves, decreasing their ability to transmit signals. This neuropathy causes several problems for those with diabetes, particularly in their feet, where many diabetes-related wounds occur.

Neuropathy can:

  • Decrease the ability to sense pain and temperature, making you less likely to notice an injury such as a blister from a shoe than doesn’t fit or a burn on your sole from walking barefoot on summer beach sand or stepping into a too hot bath.
  • Reduce awareness of exactly where the foot is in space and throw off balance, causing injuries from tripping, stumbling and stubbed toes.
  • Cause distortion of the feet’s structure, creating new pressure points where blisters and calluses can form. This occurs when muscles get fewer signals from the damaged nerves. In response, the muscles waste away. The weakened musculature makes the foot’s bones shift, distorting the proper shape of the foot.
  • Affect the autonomic system, throwing off the body’s regulation of blood vessels and sweat glands, as well as your eyes, genitals, urinary system and digestive tract, according to the American Diabetes Association. A lack of sweat and lubricants your body normally produces can cause dry skin that is prone to cracking, which can result in a wound, Dr. Flynn said.

While neuropathy ups the chances of injury, diabetes makes recovery from a wound more difficult. Poor blood circulation reduces available oxygen needed for healing, a problem especially in the legs and feet, he said.

Diabetes also raises the likelihood of wounds becoming infected, making even small injuries more dangerous and harder to resolve. This extends not only to foot wounds, but those caused elsewhere in the body by accidents or surgery.

“The whole immune system is affected by diabetes,” Dr. Flynn said.

Prevention is Key

“Prevention is the ideal way to go,” he said. “We try to do as much education as we can.”

The number one priority: proper management of diabetes to maintain low blood sugar levels, thereby limiting the ills caused by hyperglycemia. Many patients with diabetes don’t know how to protect their feet until they get into trouble, Dr. Flynn said. He recommended:

  • Inspect feet daily for signs of irritation or injury. Use a mirror to see all parts, or ask someone else to help examine.
  • Clean feet daily. Dry thoroughly afterward, particularly between the toes to prevent skin from breaking down.
  • Moisturize feet after cleaning but avoid spaces between toes.
  • Wear socks and shoes when out of bed. Don’t go barefoot or wear shoes without socks.
  • Make sure your shoes fit. Inspect their interiors for any tiny pebbles or debris that could cause injury and any rough areas that may press on your skin.
  • Immediately notify your doctor of any injury. A callus could be hiding an ulcer developing beneath it.
  • If your foot has changed shape from neuropathy, you may need to get fitted for special shoes, inserts or orthotic devices.
  • See a podiatrist regularly to trim away calluses, corns or nails. Don’t cut your feet trying to do this yourself. “For any diabetic, routinely seeing a podiatrist is really important,” Dr. Flynn said.

A common problem

An estimated 10.5 percent of the U.S. population has diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases, a part of the National Institutes of Health. Of people over 18 with diabetes, 21.4 percent – 7.3 million – are likely undiagnosed. Another 34.5 percent of American adults have prediabetes and are at risk of developing type 2 diabetes, which is associated with overeating and excess weight. The prevalence of diabetes among adults has climbed from 9.5 percent in the period from 1999 to 2002 to 12 percent in the years from 2013 to 2016, according to a 2020 report by the Centers for Disease Control and Prevention.

“Unfortunately, there’s no lack of patients for us,” Dr. Flynn said.