Diabetics with foot wounds that don't heal

Q: I have a wound on my left foot that has not healed despite treatment for the past six months. It started out as a prick I got after I stepped on a thorn. I am diabetic and did not notice the injury for a couple of days. The wound now has a foul discharge and I have problems walking as I cannot bear weight on that limb. I have visited various doctors and one of them suggested that I go to theatre for cleaning of the wound. I rejected this suggestion because I am afraid that it might lead to amputation of my foot. What would you suggest I do? Since the wound developed, I have been having problems controlling my blood sugar.

***

Foot infections in diabetics are some of the most common problems doctors encounter. In most cases, their treatment is complicated and requires a multidisciplinary approach.

Why diabetics get infections

There are several factors that contribute to foot infections in diabetics

Poor blood supply:Most diabetics do not have good blood supply to their feet. The vessels often get hardened and calcified with time after years of living with diabetes. This means that if you get an injury on your foot, it will not heal as fast as that of a person with normal blood supply.

Nerve problems: As a diabetic, it is not unusual to get injuries that you initially do not detect because most people develop nerve damage in the hands and feet after years of living with diabetes.

Weakened immunity:Poorly controlled diabetes leads to inability to effectively fight off infections. This means that if you get a wound on your foot, it has a higher risk of getting infected as compared to other people who don’t have diabetes.

Foot deformities:One of the most common issues that diabetics deal with is bony changes in the shape of the foot, which predisposes them to injury and callus formation.

Poor shoe choice:Most diabetics do not put on properly fitting shoes. Ill-fitting shoes put you at risk of getting wounds.

The management of the wound on your foot is going to be under the care of four specialists; this includes the endocrinologist (diabetes specialist), surgeon, wound care nurse and podiatrist (foot specialist).

First, it is important to get rid of the infection. This involves cleaning the wound to remove all infected material and use of antibiotics. The earlier you get it addressed, the better your outcome will be. Removal of infected tissues may sometimes need to be done theatre to ensure that it is completely excised. Once the infected tissue is removed, you will need regular wound dressing to keep the wound clean.

Next, it is vital that you get your blood sugar levels under control. Poorly controlled diabetes contributes to poor wound healing. Your endocrinologist together widietitianian should be able to help bring your blood sugar to an acceptable level.

Stop bearing weight on the affected foot. Ask your doctor for a pair of crutches if need be. Walking on the wound prevents it from healing.

In most cases, good wound care and effective blood sugar control will allow the wound to heal. The healing process, however, takes a few months and it is crucial that you are patient.

Do not be afraid, an amputation cannot be done without your consent.

If the blood supply to your foot is very poor, your doctor may refer you to a vascular (blood vessel) surgeon who will perform some procedures to improve the circulation in your leg.

When is amputation necessary?

In a patient with a wound whose infection is spreading up the leg, it may be necessary to amputate the infected part of the foot in order to save one’s life.

If spreading infection is not controlled, it can lead to blood infection, organ failure and eventual death.

In cases where there is a gangrenous (rotting) toe, it may be necessary to amputate it, to control pain and infection.

What is the role of a podiatrist? A podiatrist is a foot specialist. They help teach you how to care for your feet and prevent injury or infection.

They also help you chose or design shoes that are properly fitting (this is particularly important if you have foot deformities). There are several podiatrists in Kenya (most are affiliated to hospital diabetic and orthopaedic/bone clinics).

How to care for your feet

All diabetics must follow a strict regimen when it comes to caring for their feet.

Wash your feet daily. Ensure that you clean the spaces between your toes thoroughly. Moisture in between the toes predisposes to development of fungal infection and foot odour.

Wear properly fitting shoes— if need be, get them custom made.

Inspect your feet every day for wounds, pricks and calluses. Start treatment for them as soon as you see them.

Do not wear the same shoe for several days at a time. Ideally, change your shoes daily.

Change you — socks—daily – preferably, wear cotton socks.