Because I work in a region where diabetes is so rampant, diabetic foot infections are an everyday issue for me. Of course by the time I get them in the hospital they are rather far gone, often requiring some sort of surgery, and not infrequently, amputation. All diabetic foot infections start as a simple, uninfected wound. For various reasons, these wounds may progress into severe infections. (By the way, wounds in diabetics are most common on the feet because they are most likely to be traumatized.)
What if there was a way for a diabetic to tell that their wound is likely to become infected if they don’t act fast? Well, there is! Below, I go over 8 factors that can clue you into the possibility that, as a diabetic, the wound on your foot is likely to be infected (or to become infected).
1- The wound has been present for more than a month The presence of a wound for more than a month suggests a problem with wound healing capabilities. Also, the longer a wound is present, the more likely it is to get contaminated with germs, eventually getting infected. Infection itself, also inhibits wound healing. Infection causes inflammation which can result in death of the involved tissue; the dead tissue is then “food” for the germs and that further promotes infection. A vicious cycle occurs, until the infection is specifically treated with antibiotics and removal of the dead tissue.
2- The wound was caused by trauma, such as from walking on a piece of glass or pebble Any foreign material that is stepped on is obviously not sterile, as it is laying on the ground. Depending on how sharp the material is or how heavy the affected person is, the material punctures the foot (and sometimes remains lodged in the foot!). Germs contaminating the material, in addition to germs that were on the surface of the foot get introduced into the new wound. If the wound is not (properly) cleaned, the germs inside of it “brew” until eventually an infection develops.
3- You have had infected foot wounds in the past This automatically indicates that you are prone to getting them again and again in the future, so vigilance is very important to prevent this recurrence.
4- You already had toes or even a leg amputated Again, this shows how vulnerable you are to infection, and particularly infection that can get so complicated that it results in an amputation. Often, these are infections that have spread to the bone with too much dead tissue for the affected digit or limb to be salvaged
5- You have poor circulation This is a big problem in persons with longstanding, uncontrolled diabetes. Diabetes is actually a vascular disease, meaning, it is a direct cause of damage to blood vessels. It is often the smaller blood vessels that are involved. However, because persons with diabetes often have other medical problems including high blood pressure and high cholesterol, larger blood vessels may become damaged as well. With continued damage, inflammation and plaque formation occurs within blood vessels. Eventually plaque can become so large that the flow of blood is restricted and the tissues beyond the blockage get starved for blood. Alternatively, a plaque can crack. This results in blood cells congregating at the area forming a clot which can be large enough to block the vessel.
Diminished blood flow to a wound means that the nutrients necessary to promote healing, and the cells of the immune system responsible for fighting infection, don’t get carried to the place where they are needed most. Infection is therefore able to progress. Another unfortunate thing about poor circulation is that when antibiotics are given for an identified infection, they may not reach the site, at least not in high enough concentrations to kill the germs. In these cases, failure of curing the infection is not because of ineffective antibiotics, but because the antibiotics just don’t reach the site of infection.
6- You have neuropathy This refers to diseased or damaged nerves. Diabetes is a vascular disease as noted above with the small blood vessels being damaged first. This includes the tiny vessels which supply the nerves with blood so that they remain nourished. Because nerves get smaller as they extend to the peripheries of the body (the hands and feet) their small blood vessels are among those getting damaged. This explains why neuropathy involves the hands and feet. Sugar (glucose) itself is also toxic to nerves in high concentrations. Therefore persistently uncontrolled diabetes causes direct damage to the nerves (which is why simply controlling diabetes can result in some reversal of neuropathy symptoms).
Damaged nerves results in the sensation of pins and needles, then numbness, then eventually complete loss of feeling. Loss of feeling means that one can step on an object and sustain a wound to the foot and not know about it. Very commonly, blisters occur with a pair of new shoes. There is then repeated rubbing of the area because the affected person has no feeling to know that the blister is being traumatized. Sometimes people have blisters and ulcerations on their feet for weeks before they know there is a problem. They find out when they see drainage of pus or blood on the floor or on socks, or when there is a bad odor from far gone infection.
7- You walk around without shoes Again because of neuropathy, a wound may occur to the foot without realization. It then gets contaminated from germs on the floor. Persons with diabetes are never to walk around barefoot, and shoes should be properly fitted. Additionally, anyone with diabetes should get into the habit of inspecting their feet at the end of every day. If you are not able to see the bottom of the feet, then use a mirror or get a loved one to inspect them for you.
8- Your kidneys don’t work properly Kidney disease occurs as a result of damage to the small blood vessels supplying the kidneys. This results is leakage of protein into the kidneys. Protein is toxic to the kidneys and so continued toxicity from leaking protein, over time, results in malfunctioning kidneys. If not reversed or at least halted, kidney failure requiring dialysis occurs. The presence of kidney disease in a diabetic means that most likely other small blood vessels of the body are damaged as well, including vessels at the back of the eye, and those supplying the nerves as mentioned above.
Diabetic foot infections are definitely avoidable. The number one thing is to get the diabetes under control. And don’t wait until you already have a complication such as kidney disease, or bleeding behind the eye, etc. to think about getting it controlled. You should aim to strictly control diabetes from the moment you are diagnosed with it. Better yet, how about trying to prevent diabetes altogether by adopting diet and lifestyle modifications, especially if there is strong family history?
In the next post, I will give some tips for preventing diabetic foot ulcers. Stay tuned!