Diabetic Foot Ulcers: 5 Factors That Can Affect Wound Healing

Once a diabetic foot ulcer develops, it won’t heal without professional wound care. These non-healing wounds cause infections that can spread to your skin and bones. That’s why diabetic foot ulcers are the leading cause of amputation.

Vinai Prakash, DPM, at Lake Washington Foot and Ankle Clinic, is an expert in the intensive wound care needed to heal diabetic ulcers.

He combines board certification in podiatry and foot and ankle surgery, a specialization in wound care, and extensive experience to help patients heal from dangerous ulcers.

How diabetes causes foot ulcers

If you have diabetes, high blood sugar puts you at risk of developing foot ulcers (open wounds). Here’s how that happens:

Blood vessel damage (diabetic vasculopathy)

High blood sugar damages blood vessels. The damage restricts blood flow, preventing tissues from getting oxygen and nutrients. Vascular problems caused by high blood sugar may affect the heart, brain, kidneys, and the blood vessels in your feet and legs.

Diabetic peripheral vasculopathy (DPVD), one of the most common complications, leads to foot and ankle ulcers and peripheral artery disease (PAD).

Nerve damage (diabetic neuropathy)

High blood sugar also damages your nerves. Nerve damage (diabetic neuropathy) initially causes unpleasant sensations like tingling, burning, and pain. As the damage progresses, the nerve stops working, and numbness develops.

Diabetic neuropathy begins in your feet. The loss of sensation means you can’t feel the pain or discomfort caused by tiny cuts, irritation from shoes rubbing your feet, or pressure from common foot problems like calluses.

Vasculopathy plus neuropathy causes ulcers

Not being able to feel a cut, bruise, or callus means you may not take steps to treat it. Limited blood flow prevents healing. As a result, minor problems rapidly worsen, and an open wound develops.

Diabetic foot ulcers won’t heal on their own. If you don’t seek immediate treatment, ulcers keep enlarging, and an infection can develop.

Five factors that limit healing

The following five factors influence diabetic wounds:

1. Wound size and location

The larger the wound when you seek medical care, the more challenging it is to heal and the higher your risk of an infection. As the wound enlarges, the tissue damage can extend below the surface to affect tendons, muscles, and bones.

The wound’s location also makes a difference. A heel ulcer heals more slowly than one closer to your toes, primarily because you put more pressure on your heel.  

2. Infection and inflammation

Infection and prolonged inflammation inhibit healing. Though inflammation is beneficial in the early stages of wound healing, it interferes with healing if it lasts too long. Unfortunately, prolonged inflammation is common in diabetic wounds.

An infection dramatically slows or stops the healing process. The infection prolongs inflammation, expands the wound, and causes more tissue damage.

3. Blood sugar levels

The effect of blood sugar extends beyond blood vessel and nerve damage. High blood sugar weakens the immune system, impairing the activity of white blood cells that fight infections and help heal wounds.

4. Wound care

A bandage and antibiotic cream from your local pharmacy won’t solve the problem after an ulcer develops. The only way to ensure a diabetic wound heals is with the intensive care provided by wound specialists.

We specialize in wound therapies such as:

• Debridement (removing all bacteria and dead tissues)
• Off-loading (using orthotics, braces, and casts to take pressure off the wound)
• Advanced wound dressings
• Bio-engineered tissues (to replace skin)
• Negative pressure wound therapy (to remove fluids and infected tissues)

Today’s advanced dressings create the optimal healing environment for your wound. For example, some deliver healing substances, and others prevent water loss.

5. Nutrition and lifestyle factors

Wounds need nutrients to heal. The nutritional demands of healing, especially when you have a non-healing ulcer, can quickly lead to deficiencies. For example, collagen regulates wound healing and repairs tissues, and collagen production requires protein, zinc, and vitamin C. 

Lack of sleep, excessive exercise, alcohol abuse, and stress have an effect on healing. Smoking significantly inhibits the healing process because it reduces oxygen, impairs the immune response, and slows healing.

Expert care for diabetic wound healing

Don’t wait to seek help for a wound on your foot or ankle. Book your appointment online, or call Lake Washington Foot and Ankle Clinic to learn more about wound care.