One of the primary reasons wounds don’t heal is inadequate blood supply. Diabetic patients often suffer circulation problems. Blood supply can be compromised, particularly to the lower extremities, with narrowing or blockages of the major arteries. Disease of the smaller blood vessels is also very common in diabetics even if the large vessels are relatively normal.
Diabetics also frequently develop peripheral neuropathy, which usually decreases sensation in the feet. They may sustain trauma to their feet and be totally unaware of the wound. In the Wound Care Center we often see diabetic patients with thick callouses on the bottom of their feet, and as we remove the callus we often find deep ulcers hiding underneath.
Once a foot ulcer develops, infection can set in. Unfortunately in addition to diminished blood supply diabetics often have a weakened immune response, greatly increasing the risk of infection in the wound. Left untreated, these infected wounds frequently lead to an amputation. Over 60 percent of non-traumatic lower limb amputations are in diabetic patients. After a major amputation, either below or above the knee, less than one third of diabetic patients will still be alive after five years. This is a much lower survival rate than amputations in non-diabetic patients. Amputation also certainly contributes to a lower quality of life with less ability to exercise and improve health.