Patient/caregiver were instructed on the contribution of chronic severe vitamin B-complex deficiency for development and poor healing of diabetic foot ulcers as follows:
- Vitamins belonging to the B-complex group are very important in the synthesis of myelin, a protective tissue around the nerves to promote their normal function.
- B-complex vitamins also help in the synthesis of various chemicals in the brain, needed for normal function of the nervous system and prevent symptoms of irritability, anxiety, and depression from developing.
- Deficiency of vitamins belonging to the B-complex group can lead to damage to the nerve tissue.
- The damage to the nervous tissue can impair the ability of nerves to communicate various signals. This can compromise an individual’s response upon exposure to various sensations, such as, touch, pain, and temperature, thus predisposing the individual to increased risk for ulcer development.
- For this reason, poorly controlled diabetics with severe deficiency of vitamin B-complex group are often unable to detect the insult to their lower extremities and many wounds go unnoticed before they get infected and turn complicated.
- Over time, poorly controlled neuropathy in these individuals can also result in compromised nerve supply to the numerous small intrinsic muscles in the foot, which control the action of toes and maintain the shape & arches of the foot.
- Poor nerve supply to the intrinsic muscles of the foot leads to progressive atrophy of these muscles, resulting in stiffness & contractures of the toes, compromised arches of the foot, and altered gait patterns.
- Altered shape of the foot in these individuals can further lead to increased exposure of the foot to mechanical factors, such as, friction, pressure, and shearing stress.
- Enhancement or worsening of effects of mechanical forces on the feet of poorly controlled diabetics contribute to increased risk for development of new pressure points and calluses on the foot. These new pressure points and calluses carry potential to progress in future towards development of new diabetic foot ulcers.
- Altered pressure dynamics on the feet of diabetic patients contribute to worsening of existing foot ulcers, if any, resulting in poor healing. Also, compromised pain sensitivity in the extremities of poorly controlled diabetics allows these individuals to continue ambulating around on an ulcerated area of the foot, without realizing the ulcer, thus exposing the site to increased risk for infection and poor healing.
