Patient/caregiver were instructed on the pathophysiology of diabetic foot ulcers as follows:
- Nerves, in general, help communicate various signals, such as, touch, pain, changes in temperature, changes in an individual’s position, etc.,
- Poorly controlled blood sugars in diabetic patients over time result in increased production of toxic inflammatory chemicals in the body. Chronic exposure of the nerve tissue to these inflammatory chemicals lead to progressive damage to the nerves.
- Rich supply of oxygen and nutrients are needed for repair of the damaged nerve tissue. But the toxic inflammatory chemicals in poorly managed diabetics, in addition to damaging the nerves, can also damage the small blood vessels supplying the oxygen and nutrients. Also, poorly controlled blood sugars can contribute to atherosclerosis in these individuals, thus increasing the fat deposition on the inside of blood vessels, decreasing their lumen, and progressively reducing the blood flow through the involved blood vessels. This can impair the supply of oxygen and nutrients to the nerve tissue in repair, which makes the repair difficult, thus turning the damage permanent over time.
- This chronic damage to the nerve tissues can lead to diabetic neuropathy, impair the ability of nerves to communicate various signals, and compromise an individual’s response upon exposure to various sensations.
- So, individuals with diabetic neuropathy often fail to realize the pain due to injury from sharper foreign objects like a metal piece or nail or due to injury from an ingrowing toenail. Mechanical injuries from rubbing of the body part against any sharp edges or chronic friction with the foot rubbing against the floor surface during ambulation could also be poorly realized by individuals with neuropathy. They also often fail to realize a hot patch or a cold compress placed on their body, which can stay in place for longer duration than recommended, resulting in burn injuries or frostbite.
- The damaged nerve tissues can involve various body parts, especially the distal lower extremities, feet & toes, resulting in increased risk for skin integrity and development of diabetic foot ulcers.
- Due to compromised sensation, individuals with diabetic neuropathy are often unable to detect the insult to their lower extremities and many wounds go unnoticed before they get infected and turn complicated. Also, the wounds on the feet and toes could progressively worsen, as the affected portions of skin are continuously subjected to repetitive pressure and mechanical forces from weightbearing and ambulation of the individual.
