Diabetic cut on foot

7 Ways to Care for Foot Wounds If You Have Type 2 Diabetes

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If you have type 2 diabetes, even a small cut or scrape can turn into a serious problem. The reason: If your blood sugar levels are too high, your arteries can become stiff and your blood vessels can become narrowed. That, in turn, hinders your blood flow and cuts off some of the oxygen and crucial nutrients that are needed to help your wound heal, says Deena Adimoolam, MD, an assistant professor of diabetes, endocrinology, and bone disease at the Icahn School of Medicine at Mount Sinai in New York City.

Small wounds can also become infected from the bacteria on your shoe or the environment — and if they do, chronically high blood sugar can impair the function of immune cells that fight against infection. A high sugar environment also helps bacteria, fungi, and other infection-causing organisms to thrive, adds Dr. Adimoolam.

Plus, a local infection can spread to other soft tissue or to bone and even your blood, which can lead to sepsis, a dangerous and potentially life-threatening level of infection, says Jacqueline Sutera, DPM, a podiatrist at Hackensack University Medical Group in Emerson, New Jersey, and a spokesperson for the American Podiatric Medical Association.

Diabetic neuropathy — a condition that damages nerves in the legs and feet, leading to a loss of sensation — further complicates the issue. “When people with diabetes lose sensation in their feet, it’s quite difficult to walk, and they end up putting increased pressure on only certain parts of the feet that can sense the floor,” Adimoolam says. The constant pressure on certain areas of the feet may cause skin breakdown and ulcers.

Nerve damage can also prevent pain signals that would otherwise help you know when you have a minor foot issue, like a splinter, ingrown toenail, or even when your shoe is rubbing the wrong way, says Dr. Sutera.

About 15 percent of people with diabetes will develop a wound over the course of the disease, according to the American Diabetes Association. However, if you take preventive steps and get the proper treatment, you can avoid a serious infection.

How to Treat Foot Wounds

Having type 2 diabetes doesn’t mean that you’re destined to develop a serious foot wound. Follow these steps to help prevent injuries and help them heal faster.

Keep your blood sugar levels down. Poor circulation, neuropathy, and a weakened immune system can all be improved with good control of your diabetes, Adimoolam says. Your diabetes educator and doctor can help you develop an individualized plan to keep your blood sugar stable.

Quit smoking. It’s a risk factor for poor circulation, which increases your susceptibility for wounds and poor healing, Adimoolam explains.

Wear well-fitting shoes. One of the best ways to ward off a foot injury is to wear protective shoes that fit well. Avoid shoes that are too thin, flat, or high, and use custom insoles to reduce pressure. If you have neuropathy, it’s best to avoid walking around barefoot, even in your house, Sutera says.

Keep your feet clean and your nails trimmed. Wash your feet with soap and water every day and apply lotion to the entire foot to avoid cracked skin, Adimoolam says. Trimming your nails can help prevent an ingrown toenail, but patients with neuropathy should see a podiatrist for nail trimming.

Do a daily foot check. Inspect the skin on your feet, including the area between your toes. If you can’t see your entire foot, use a mirror or take pictures at several angles with your cell phone. Serious problems can happen as quickly as overnight, Sutera says, so don’t delay seeing your doctor if you notice a wound.

Learn to spot the warning signs. Callouses are often the first sign that you’re putting pressure on certain areas of your feet, which can lead to an ulcer, Adimoolam says. Look for callouses and see your doctor if they become red and painful. Also look for cuts, blood, tenderness, a foul-smelling discharge, swelling, or black or blue skin. If you notice any of these changes, see your doctor right away. Also, if you can’t walk because of pain or tenderness, that’s a sign that you may have a wound that’s getting worse, she says.

Treat a wound immediately. If you find a wound, clean it with gentle soap and water, apply an antibiotic ointment, and cover it with a bandage, Sutera says. Repeat this process twice a day and keep it covered in the bath or shower. If there’s any swelling, pus, or drainage; or it looks, feels, or smells bad, get it checked out. Typically, superficial wounds heal within 5 to 7 days, but if it doesn’t, be sure to see your doctor.

No matter how careful you try to be as you go through life, minor cuts, scrapes, bruises and sometimes even more serious wounds do happen. When the injury occurs on your feet, heels or ankles, it can be especially painful and hard to heal. That’s why proper care and treatment for a foot wound from the very moment it occurs is very important to ensure proper healing.

John Viscovich, DPM, MBA, FACFAS

As a podiatrist with Westchester Health, I’ve noticed over the years that many people lack a good working knowledge of how to care for wounds that need immediate attention but are not serious enough to warrant a trip to the emergency room. To help rectify that, I’ve put together some guidelines that explain what to do in case you do sustain an injury to the foot, ankle or lower leg.

9 first aid tips for proper wound care

First and foremost, before treating any kind of wound or burn, WASH YOUR HANDS. In addition, wear disposable protective gloves, if possible.

Next, follow these 9 tips to avoid infection and promote healing.

1. A little blood is good

Blood helps clean a wound, so a little bleeding is actually beneficial. Most small cuts and scrapes stop bleeding fairly quickly on their own, but you can help the process by applying firm, gentle pressure to the site with a sterile gauze, towel or tissue. If blood soaks through the wrapping, add another layer of gauze or tissue on top. Do not remove the original dressing or you may pull open the wound and start the bleeding again.

2. Clean wounds right away

For any cut or scrape, the first thing to do is clean the wound with cool water. Remove any gravel or splinters with alcohol-sterilized tweezers. Gently wash around the wound with soap and a washcloth. Do not use iodine, alcohol or hydrogen peroxide— just soap and water.

3. Apply antibiotic cream

Antibiotic creams and ointments not only keep wounds moist but they can also reduce the risk of infection. Apply a thin layer on the wound, but if a rash develops, discontinue use.

4. Cover with a bandage

If your wound will be rubbed by clothing or shoes, cover it with a bandage. An uncovered cut or scrape is at risk of reopening or developing an infection. What often works best is to cover the wound with gauze, then wrap a fabric bandage over and around that to prevent bacteria from coming in contact with the wound. Change the bandage daily.

5. Watch for signs of adhesive or latex allergy

If you feel itchiness or burning under your bandage, you may have an allergy to the adhesive used in some bandages. If this happens, try switching to sterile gauze and paper tape or an adhesive-free dressing.

6. Healing begins almost immediately

Almost as soon as you sustain a wound injury, your body begins the healing process. White blood cells attack infection-causing bacteria. Platelets, red blood cells and fibrin create a jelly-like clot over the wound, enabling a protective scab to form.

7. Treating minor burns

The best treatment for a minor burn is to cool the area right away with a cold cloth or cool water to keep the skin from retaining the heat and continuing to burn. After cooling it to stop the burning process, wash the burned area with soap and water and dress it lightly. Leave blisters alone and do not pop them; they help protect the skin as it heals.

8. Look for signs of infection

If redness spreads out from the injury site, if there is swelling, if green or yellow fluid is emerging from the wound, or if the area around the wound is warm or tender, you may have an infection. Other signs include body aches, chills, fever and/or swollen lymph nodes at your neck, armpit or groin. If you have any of these symptoms, call your doctor right away.

9. See a doctor right away if your wound:

  • won’t stop bleeding after 5-10 minutes of pressure
  • is deeper or longer than a half-inch
  • is near the eye
  • is gaping or ragged
  • was caused by something dirty or rusty
  • has dirt or gravel stuck in it
  • is very painful
  • shows signs of infection
  • was caused by an animal or human bite
  • includes a broken or fractured bone
  • if you aren’t sure if you’re up to date on your tetanus vaccine

First aid tools everyone should have

Since you never know when you or something around you will sustain a minor or major injury, it’s a good idea to keep these first aid items handy:

  • tweezers
  • hydrocortisone cream
  • hand sanitizer
  • sterile gloves
  • pain relievers
  • gauze and tape
  • antiseptic wipes
  • antibiotic cream
  • antihistamines for allergic reactions

If you’ve been injured and are concerned about the wound

If you’ve sustained a cut, scrape or something more serious and want to know if it’s healing correctly, or have any concerns about your feet, please call (914) 232-1919 to make an appointment to come see me at one of my Westchester Health offices. I’ll examine the wound, evaluate the overall condition of your feet, and together with you, determine the best course of treatment to bring about proper healing. Whenever, wherever you need us, we’re here for you.

By John Viscovich, DPM, MBA, FACFAS, board certified podiatrist with Westchester Health, member of Northwell Health Physician Partners

Your doctor will know the proper way to clean and treat the wound. He may prescribe a cream to use at home.

If you develop a foot ulcer, the doctor will probably have to clean it out. He may call this process debridement. Then he’ll bandage it if it needs it, Guzman says.

In recent years, cutting-edge treatments like stem cells and growth factors have been used to treat foot ulcers. “These are no longer extreme measures,” Brem says.

You should also keep weight off of your foot as you heal. There are different types of casts or boots the doctor can give you to help, Guzman says.

Go With a Preventive Defense

Your best bet to avoid sores is to keep your feet healthy. Here’s how:

  • Check your feet daily. If you’ve lost feeling in your feet, look to see if something is wrong. It’s hard for many people to inspect the bottoms of their feet even if they use a mirror, Guzman says. Ask a spouse or friend to help you.
  • Wash them well. When you shower, soap your feet with warm water and fully dry them, even between the toes. Moisture that gets trapped there can be harmful. Use lotion or cream to keep skin from drying or cracking, which can cause sores. “Treat your skin as the most important organ in the body,” Brem says.
  • Dress for comfort. Keep your feet cushioned with soft socks and comfy footwear. Avoid high heels and pointy, narrow styles, which can harm your feet. Your doctor may prescribe special shoes if you need them. “Shoes are extremely important,” Brem says. “Something like can be the difference between a significant ulcer and not. You need proper padding.”
  • Trim your toenails. People with diabetes should see a podiatrist, a doctor who specializes in foot care. Ask him if he should cut your toenails to prevent injury. This is common for people who have neuropathy or who’ve had foot ulcers before. “Only have an expert clip your nails if you have diabetes,” Brem says. “Never go to a salon.”

Foot wounds must not be ignored by those of us with diabetes as there are very serious consequences if foot wounds do not heal properly.

A wound which does not heal properly and is left exposed may form a foot ulcer which further raises the risk of an infection occurring.

Indeed, if a wound becomes infected, amputation is a very real prospect if medical attention is not received quickly, as a result of severe complications like gangrene

Gangrene

Gangrene is a serious medical condition that comes in two type, known as “wet” and “dry” gangrene. They are caused by bacterial infections or pre-existing health-issues respectively. Unfortunately, diabetics are at risk of both types.

Gangrene is caused by a lack of blood flow to a certain part of the body, and so diabetes can cause “dry” gangrene by destroying blood vessels. Diabetics can also be at risk of the infections that destroy blood vessels or block off blood flow due to swelling because they have a weakened immune system.

  • See here for more information on gangrene, what to do and how to prevent it

Signs of foot wounds

Foot wounds are any break in the skin and therefore include any of the following that causes skin to be lost or open out:

  • Cuts
  • Grazes
  • Blisters
  • Cracked skin
  • Loss of skin following a corn or callus
  • In grown toenails pressing against the surrounding skin

If you notice any signs of wounding, or any of the above signs that can lead to wounds, make an appointment to see your GP.

If a wound has gone unnoticed or heals slowly, the affected area may grow larger and become a foot ulcer. Having a foot ulcer increases the risk of infection so it’s important to notify your GP or podiatrist as soon as possible.

Symptoms of infection

The following symptoms at the site of the wound may indicate that the foot has become infected:

  • Swelling
  • Reddening of white skin, darkening of brown or black skin
  • You may experience increasing amount of pain
  • Skin feels warm to the touch
  • The appearance of pus

Infection may be accompanied by other symptoms including:

  • Having a high temperature
  • Swollen glands
  • Feeling lethargic and unwell

If you notice these signs arrange to see your GP or health team with a day and if this is not possible, visit your A&E (Accident and Emergency).

Causes

Cuts, grazes and blisters are more likely to occur if you don’t wear comfortable fitting footwear or if you walk around bare foot.

Damage can also occur from activities including:

  • Dropping objects on your feet
  • Stubbing your feet
  • Being trod on
  • Burns or scalding from hot water or heaters
  • Accidents when clipping toenails

People with diabetes need to extra careful because diabetes can affect the sensory nerves in the feet which can mean suffering wounds without noticing.

If wounds are not well protected, there’s a greater risk of infection and another key factor is that wounds tend to heal more slowly in people with diabetes

Complications

If wounds do not heal properly, the wounds may form an ulcer where the surface of the skin breaks down over an area of the skin leaving the tissue underneath exposed.

It’s important that foot ulcers are treated immediately as infection can set in which can significantly raise the risk of amputation if it causes gangrene or spreads to infect the bone.

Treatment

If you develop a wound, it’s important to:

  • Clean the wound in a bowl or warm but not hot water.
  • Cover the wound with a sterile wound dressing or bandage to prevent any infection getting in.
  • Clean the wound and change the dressing or bandage each day.
  • Ensure you do not aggravate the wound and limit how much your walk on it.
  • Notify your health team, who will be to advise you on any other treatment or precautions you should take.

Let your doctor know if there is, or could be, an object in the wound, such as a splinter or piece of debris such as glass or metal.

Treatment for infected wounds

If the wound has become infected you need to seek medical help immediately. An infected wound can be treated with antibiotics but people with diabetes may often require additional care to help ensure the wound heals properly.
If you cannot see your GP or a member of your health team within a day, go to your nearest A&E (Accident and Emergency).

Preventing wounds and infections

You can help to minimise the risk of wounds occurring by wearing comfortable, well-fitting shoes which will help to reduce the chances of developing blisters, calluses or other foot problems such as hammer toes.

Avoid walking around bare foot to prevent the risk of cuts, burns or grazes occurring. Remember that if you have nerve damage (neuropathy), you may not feel pain should a foot injury occur.

Check your feet each day for signs of damage or any changes in feeling or appearance in your feet. If you notice something different, notify your doctor. Don’t wait to see if things get better as this can sometimes lead to getting the treatment you need too late.

  • See our guide to foot symptoms for further information

Try to maintain good control of blood glucose levels as well as this will help any wounds you’ve suffered to heal more quickly.

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