Diabetes: Treating Wounds and Injuries

No matter how small or superficial a wound is, you should not ignore it if you have diabetes, says Daniel Cohen, DPM, a podiatrist with Medical Associates of Brevard in Brevard County, Fla. If you stub your toe, get a blister from tight shoes, or nick your chin while shaving, you probably give it little thought. But if you have diabetes, you should seek proper treatment.
Knowing how to treat minor wounds will help you avoid infection and speed healing.

Why Diabetic Wounds Can Cause Problems

Diabetes is a chronic disease where your body can't use glucose, or sugar, the way it should. It can cause a number of complications, including some that make it harder for wounds to heal. These include:

• Nerve damage (neuropathy). When you have neuropathy, you may not feel the pain of a cut or blister until it has grown worse or become infected.
• Weakened immune system. When the body's natural defenses are down, even a minor wound may become infected.
• Narrow arteries. People with clogged arteries in their legs are more likely to develop wounds, have severe wound infections, and have problems healing. Narrowed arteries makes it harder for blood to get to the wound. Blood flow promotes healing, so anything that blocks it can make wounds more likely to become infected.

How to Treat a Diabetic Wound

If you have a wound, no matter how small, take the following steps to avoid infection and promote healing:

• Take care of the wound immediately. Even a minor wound can become infected if bacteria are allowed to build up after injury.
• Clean the wound. Rinse the wound under running water to remove dirt. Don't use soap, hydrogen peroxide, or iodine, which can irritate the injury. Then apply antibiotic ointment to prevent infection, and cover the wound with a sterile bandage. Change the bandage daily, and use soap to clean the skin around the wound. Inspect your wound daily for any signs of infection.
• See your doctor. Don't take any chances -- have your doctor check minor skin problems or areas of redness before they turn into larger problems. Err on the side of caution, says podiatrist and wound specialist Robert Snyder, DPM, medical director of the Wound Healing Center at University Hospital in Tamarac, Fla., and incoming president of the American Academy of Wound Management in Washington, D.C. "It's far easier to treat a minor skin problem before it becomes serious," he says.
• Keep pressure off the wound as it heals. For example, if your wound is on the bottom of the foot -- a common place for diabetic people to develop calluses and blisters -- stay off it as much as possible so it will have a better chance to heal, says Snyder.

Foot Wounds Are Dangerous

Feet and ankles are particularly vulnerable to diabetic wound problems, according to Cohen. "Wound healing below the knee is a different dynamic than in other parts of the body," he says. "These areas are prone to swelling, which can inhibit healing. Also, if you have a wound on your arm, you can immobilize it. This is much harder with a foot wound."
But it's not easy for people with diabetes to avoid foot wounds because they are more likely than other people to have calluses, dry skin and nerve damage. All of these combined  can lead to an increased risk of ulcers (open sores) and can lead to infections. Along with loss of  feeling in their feet, many people with diabetes also have vision problems. So they may neither feel nor see a small wound until it becomes serious, says Snyder.  
A wound that becomes serious may do more than cause pain and inconvenience. It may cause so much damage to tissue and bone that amputation becomes the only option.
Research shows that an ulcer precedes most lower limb amputations in people with diabetes. That's why it's so important to care for a wound before it becomes serious -- or, if at all possible, prevent wounds in the first place.

How to Prevent Wounds

The best way to avoid wound problems is to prevent wounds in the first place:  

• Check your feet daily. Look for blisters, calluses, chafing, and redness. "This is the single most important thing you can do to avoid diabetic foot problems," says Cohen. If you have trouble seeing, have someone else check your feet every day.
• Pay attention to your skin. Check for small, seemingly minor skin problems like infected hair follicles or inflamed areas around the fingernails. If you notice a problem, speak with your doctor.
• Moisturize your feet. Use moisturizer to keep the skin on your feet soft and supple. But don't use lotions between your toes because this can lead to an fungal infection. To treat athlete's foot, Cohen recommends using a gel rather than a cream antifungal product because gels don't leave a moisture residue between the toes.
• Wear proper footwear. Wearing well-fitting shoes can help you avoid blisters. Closed-toe shoes reduce the risk of foot injury. "We advise our patients to wear close-toed shoes, even around the house, " says Cohen. If you have trouble finding shoes that fit properly, speak to your doctor. You may need a custom-made shoe.
• Inspect your shoes every day. People with diabetic neuropathy may walk around with a pebble or other object in their shoe without knowing it is there, says Snyder.  You should also check for tears or rough areas on the inside of the shoe.
• Choose the right socks. Buy socks that wick moisture away from skin.  Avoid socks with seams. Socks made specifically for people with diabetes are available in many specialty stores and online.
• Wash your feet daily. After washing, dry them carefully, including between the toes.
• Smooth away calluses. After your bath or shower, use an emery board or pumice stone to gradually remove calluses. Never cut calluses with  scissors or a nail clipper.
• Keep toenails clipped and even. Ingrown toenails can lead to foot problems. Have your doctor check your feet regularly.
• Manage your diabetes. Preventing serious foot wounds also means keeping your diabetes under control. This includes monitoring blood sugar, blood pressure, and cholesterol levels; eating healthfully; taking the medications your doctor prescribes; exercising regularly; not smoking; and having regular medical checkups.

Snyder emphasizes the importance of consistent preventive care for people with diabetes. "If you have diabetes, you should have a team of specialists who you see for regular medical checkups, including a podiatrist and an ophthalmologist, as well as your primary care doctor," he says.

By Constance Matthiessen
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