Patient/caregiver were instructed on the contribution of chronic severe alcoholism for development and poor healing of diabetic foot ulcers as follows:
- Chronic alcoholism is considered to be a potential risk factor for increased insulin resistance and incidence of type 2 diabetes mellitus.
- Continued excessive alcohol intake in diabetic individuals can worsen the insulin resistance further and lead to poorly managed blood sugars.
- 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 and impair the ability of nerves to communicate various signals.
- This results in compromise of an individual’s response upon exposure to various sensations.
- For this reason, individuals with poorly controlled diabetes are often unable to detect the insult to their lower extremities and many wounds go unnoticed before they get infected and turn complicated.
- Poorly controlled neuropathy in the foot during later stages 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 individuals with neuropathy can further lead to increased exposure of the foot to mechanical factors, such as, friction, pressure, and shearing stress, contributing to poor healing of diabetic foot ulcers.
- Compromised pain sensitivity in the extremities of poorly controlled diabetics allows these individuals to continue ambulating around on an ulcerated area of the foot, thus exposing the site to increased risk for infection and poor healing.
- Also, this can increase the risk for development of new pressure points and calluses on the foot with potential to progress in future towards development of new diabetic foot ulcers.
