A diabetic foot ulcer is an open sore or wound that usually occurs on the bottom on the foot. It occurs in about 15 percent of diabetic patients. In industrialized nations, diabetes in the number one cause for amputations. Foot complications are the dominant cause for diabetic hospitalizations. Exercise and risk factor management can improve the clinical outcome for diabetic foot ulcers.
Adverse Effects of Diabetes on Tissues
Diabetics often have stiff narrow blood vessels that impede blood flow and diminish delivery of oxygen and nutrients needed for wound healing. Elevated blood sugar decreases red blood cell permeability and flow, impairs the release of oxygen from hemoglobin, and hinders functioning of white blood cells. These factors mitigate against the short- and long-term ability to fight infection. Infection that is not immediately eradicated is an infection that is allowed to spread, which raises the risk of gangrene, sepsis and osteomyelitis or bone infection. Increasing severity of infection increases the risk for amputation which negatively impacts quality of life and longevity.
Risk Factors
According to the California Podiatric Medical Association, diabetics, African Americans, Native Americans, older men, insulin dependence and people with diabetic eye or kidney disease, heart disease, peripheral vascular disease or PAD are at risk for the development of diabetic foot ulcers. A history of previous amputation, lower extremity nerve damage, structural foot deformities, limited joint mobility, obesity, alcohol consumption and smoking are additional risk factors.
Preventive Measures
Control of blood glucose and elimination of cardiovascular risk factors, smoking cessation and weight loss are essential measures in risk factor management. Diabetics can further reduce risk for foot injury by not ever walking bare foot. Additional measures are having your shoe size measured every time you buy a pair of shoes and avoidance of pointy-toed shoes and high heels. Ill-fitting shoes are a factor in 50 percent of the foot infections that lead to amputation. Diabetics should wash their feet daily, cut their toenails straight across, never try to remove their own corns, callouses or warts, wear comfortable loose socks and shoes that allow wiggle room for all the toes. Adequate nutrition is also an essential element in efficient wound healing.
How Exercise Helps
Chronic inflammation is a common factor in many degenerative diseases such as diabetes. As of the time of this article, Dr. Todd Keylock of Bowling Green State University is studying the effects of exercise on the healing of diabetic wounds. Keylock says: "We think regular, aerobic exercise can maintain and restore health by reducing chronic inflammation." Exercise can also help reduce some of the risk factors for diabetic foot ulcers via weight loss and improvements in blood glucose, PAD, heart disease and high serum cholesterol and triglycerides. If you are diabetic or have any of the risk factors for foot ulcers, talk with your healthcare providers to create an plan that includes exercise that will help you to reduce your risks of getting diabetic wounds.
References
- Wound Healing Perspectives; Nutrition and Wound Healing; 2007
- Dr. Nelson Clinic.com; Diabetic Wound Care and Foot Ulcers; October 13, 2010
- Bowling Green State University; Exercise Could Speed Wound Healing in Diabetics; April 6, 2011
- Medline Plus; Diabetes - Foot Ulcers; June 3, 2011
- "American Family Physician": Diabetic Foot Ulcers: Prevention, Diagnosis and Classification; David G. Armstrong, D.P.M., and Lawrence A. Lavery, D.P.M., M.P.H.
