Category 1: Mechanical reasons: Sometimes foot wounds are caused by issues with internal foot structure. Diabetic foot ulcers, for example, develop for reason. The reason is usually some kind of pressure point over a bone deformity of some kind that creates a callus and then subsequently an ulcer. Fortunately, there is a lot that can be done about this. In my experience, this is by far the most important category in diabetic foot care. Correction of mechanical issues that are contributing to pressure points can play a significant role in healing wounds.
Category 2: Neurologic reasons: Almost all diabetic foot wounds occur because there is some loss of sensitivity in the patient’s foot. A great deal can be done to help preserve that sensitivity and prevent foot wounds. No patient with a fully sensitive foot ever gets a diabetic foot ulcer.
Category 3: Vascular reasons: There is an unfortunate minority of patients with diabetes who have severe peripheral vascular disease. Sometimes the vascular disease is so severe that not enough blood gets to the wound to allow it to heal. This is a very difficult situation to deal with and often ends up in an amputation. Only about 10-20% of patients with diabetic foot ulcers have significant vascular compromise that causes the ulcer. If circulation cannot be restored with surgery, the prognosis for vascular diabetic foot ulcers is very poor.
Category 4: Cellular and chemical reasons: These problems occur primarily because of elevated blood sugar. The elevated blood sugar apparently has a detrimental effect on the normal chemicals and cells that are required for adequate healing. Activation of certain cells like macrophages and keratinocytes doesn’t happen as well in patients with diabetes. There are over 100 physiologic factors in patients with diabetes that may be deficient for proper wound healing. There isn’t a lot you can do about this category. These deficiencies are not easily understood, diagnosed or treated. There are several medications that can be applied to wounds to try and restore the physiologic environment that is conducive to healing. Unfortunately, these medications are quite expensive. The simple search of medical research demonstrates huge amounts of money being devoted to try and identify on a cellular level what slows diabetic foot wounds from healing. Unfortunately, most of the studies don’t take into consideration category 1. Therefore the mechanical forces that caused the ulcer in the first place are frequently not addressed and the ulcers take months to heal.
Whatever the reason may be behind your slowly healing foot wound, you need to seek treatment immediately. If you're in the San Antonio area, contact Next Step Foot & Ankle Clinic in Universal City, TX at (210) 375-3318 or Pleasanton, TX at (830) 569-3338 to schedule an appointment with Dr. Darren Silvester. You can also reach us online to arrange your first visit and get the treatment you need.