Patient/caregiver were instructed on the contribution of uncontrolled chronic smoking for development and poor healing of diabetic foot ulcers as follows:
- 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.
- Rich blood supply delivering fair amounts of oxygen and nutrients is needed for repair of any damaged nerve tissue.
- Continued chronic smoking by individuals can lead to progressive shutdown of small blood vessels, especially in distal lower extremities, thus 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 damaged nerve tissue and foot ulcer sites, if any, secondary to coexisting factors, such as, poorly controlled diabetes.
- This makes the repair of nerve tissue and foot ulcer sites, if any, difficult. This predisposes the individual to permanent nerve damage, risk for skin integrity, and development and/or poor healing of diabetic foot ulcers.
- 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.
- Altered gait 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.
- 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, thus exposing the site to increased risk for infection and poor healing.
