As we continue our focus this month on the topic of diabetes (especially as it relates to the foot and ankle) we hope to empower and educate you on how to effectively cope with a disease that can be overwhelming. Whether you yourself have diabetes, or you care for a friend or loved one with the disease, we want to assure you that with a few adjustments and regular visits to your podiatrist, foot and ankle diabetic complications can be successfully managed. Real effort, determination, compliance, and patience are prerequisites for success. With that being said, today’s discussion centers around diabetic ulcers and what you can do as either a caregiver or a patient to speed up or enhance their healing.
The Persistent Ulcer
Ulcers have been afflicting diabetics since the disease was first recognized. They have been a source of frustration for both the patient and the doctor. It is not an unusual occurrence for one ulcer to heal just for another one to appear in a different location, or even the ulcer recurs in the same place. In some instances additional circumstances may preclude an ulcer from healing. The following 5 tips are by no means a guarantee that an ulcer will heal, but can create the most favorable environment for success to occur.
1. Good Blood Sugar Control
Recent studies have shown that the most important factor in diabetic wound healing is the establishment of normal glucose control. The sugar in our blood plays many key and complex roles in how are tissues heal on a molecular level. If we have excess levels over a prolonged period, unfavorable molecular byproducts can build up resulting in a delayed healing. In addition to these byproducts, too much glucose interferes with the inflammatory process needed for wound healing by preventing certain compounds and products such as Vitamin C to be used in the healing process. In general, monitoring your HbA1c provides a good predictive value as to how quickly your wounds will heal. Recent studies have shown that the closer your HbA1c is to normal, the quicker your wound will heal.
2. Stop Smoking
If you don’t smoke or have never smoked, feel free to move on two tip #3. For those of you currently smoking please listen up, as many substances in tobacco have a direct negative consequences on wound healing. For example, nicotine found in cigarettes causes blood vessels to constrict which diminishes the amount of blood flow and nutrients delivered to the site of the wound. One cigarette can constrict blood vessels in this fashion for up to 90 minutes. This shows that a full pack of cigarettes would have this effect on blood vessels all day long.
3. Wear your boot and other devices at home.
One of the mainstay treatments of diabetic wounds and ulcers is to relieve pressure from the site of the wound allowing it to heal without further damage. This is achieved by wearing either casts, walking boots, pads, and other devices. For the most part, patients do really well wearing these devices when out of the house, however this has proven to not be the case when at home. In another recent study, researchers determined that people were just as active at their houses as they are when they leave their homes. It was also shown that study participants who were the most diligent only wore their devices 60% of the time. In addition, while out and about, 85% of patients wore their boots, but when at home, only 15% of patients continued to wear their boot or offloading device. Moral of the story is that although it might seem more comfortable to not wear the boot at home, you are really doing yourself a disservice.
4. Proper Nutrition
It goes without saying that nutrition plays a major role in all physiologic processes in our bodies, so it is with wound healing. As we have already discussed, Carbohydrates or sugar plays a vital role that will either enhance or hurt wound healing. Protein and amino acids are likewise very important in the healing cascade. Vitamins such as Vitamin C and Vitamin A play critical roles in cellular mechanisms to promote the proper inflammation needed to achieve wound resolution. Deficiencies or excesses in any of these areas can impede healing and may even be detrimental to overall health. Consult with your doctor to determine if you may be lacking in any of these nutrients. Do your very best to consume a balanced diet rich in appropriate amounts of carbohydrates, protein, fats, vitamins, and minerals.
5. Reduce Stress Levels
Usually when someone mentions stress as a possible cause for adverse health outcomes, it is quickly brushed aside. The reality is however, that stress causes the body to respond by releasing a product called cortisol. This has many physiological consequences, including delayed healing. Stress can also deplete stores of Vitamin A, Zinc, and amino acids such as arginine that are all players in wound resolution. While it is easier said than done, reducing stress while in the face of ulcer complications may decrease your healing time. This can be difficult as ulcers can be frightening and distressing, but do the best that you can. If you are experiencing excessive anxiety from your ulcer, seek the professional advice of your doctor as he or she may be able to prescribe cognitive behavioral therapy, medications, or professional counseling. Also, seek out wholesome activities that you find enjoyable and soothing.
With these few tips in mind, always remember that you can count on a multispecialty team of professionals who have your best interests in mind. Don’t hesitate to schedule an appointment with Dr. Gary N. Friedlander of Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.