Why do diabetic wounds heal slowly PTP

Diabetic ulcers (Diabetic Ulcer) often occur on the feet, especially at the tips of the toes and the ball of the foot. Let&#8217;s find out why diabetic ulcers heal slowly, the signs that indicate the wound is infected and spreading, as well as how to care for the feet of diabetic patients to prevent the wound from worsening to the point of amputation.
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Diabetic ulcers (Diabetic Ulcer) are chronic wounds caused by complications of diabetes. They are commonly found on the feet, especially at the tips of the toes and the ball of the foot, which are weight-bearing areas. This causes accumulated pressure, and even minor friction or injury can easily develop into a wound.
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Most diabetic patients have peripheral neuropathy, which reduces sensation, and also have circulatory problems, especially in the feet. This results in slower wound healing compared to the general population. They are also at risk of infection and severe wound progression if not properly cared for.
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<h2>Why do diabetic ulcers heal slowly? Factors affecting the wound healing process</h2>
Diabetic patients often experience chronic wounds that heal slowly due to multiple factors. The main factors affecting wound healing are as follows:
<ul>
<li>Peripheral neuropathy abnormalities in diabetic patients reduce sensation, causing patients to be unaware when wounds occur and thus not receive timely care. Additionally, nerve abnormalities affect muscle function, leading to foot deformities. Some areas of the foot bear excessive pressure, increasing the risk of wounds and slowing healing.</li>
<li>Poor blood circulation due to narrowed or blocked blood vessels, especially in the feet, resulting in reduced blood flow to the wound tissue.</li>
<li>Weakened immunity from poor diabetes control, leading to reduced immune function and increased susceptibility to infection. Chronic high blood sugar levels worsen immunity, causing wounds to become infected and spread rapidly.</li>
<li>Improper foot care such as wearing ill-fitting shoes, not inspecting feet daily, and neglecting minor warning signs, leading to undetected early wounds that worsen and become harder to treat.</li>
</ul>
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<h2>Signs indicating the wound is infected and spreading</h2>
Infection in diabetic wounds affects the healing process and can lead to severe complications. If left untreated, it may cause tissue necrosis, sepsis, or require partial amputation. If patients notice the following signs, they should see a doctor immediately for proper diagnosis and care:
<ol>
<li>Discharge from the wound such as pus, serous fluid, or foul-smelling liquid, indicating bacterial infection.</li>
<li>Increased pain in the wound which may indicate inflammation or spreading infection.</li>
<li>Swelling, redness, or abnormal warmth around the wound indicating inflammation caused by infection.</li>
<li>Skin discoloration around the wound turning dark purple or blackish-brown, which may signal gangrene due to tissue ischemia.</li>
<li>Fever, chills, fatigue, or body aches warning signs that the infection may have entered the bloodstream, leading to sepsis.</li>
<li>Wound not healing or not improving within 10 days, requiring prompt medical attention.</li>
</ol>
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<h2>How to care for the feet of diabetic patients to prevent diabetic foot ulcers</h2>
Regular foot care is essential for diabetic patients because they often have circulatory problems and reduced sensation, making them unaware of small wounds that can worsen and lead to severe complications. Proper foot care reduces risks and prevents wounds. Recommended practices include:
<ul>
<li>Inspect feet daily to observe any abnormalities such as redness, wounds, cracks, or swelling for early treatment.</li>
<li>Wash feet cleanly once or twice daily using mild soap and dry thoroughly, especially between the toes, to prevent moisture that can cause fungal infections.</li>
<li>Apply lotion to moisturize the skin and reduce cracking, avoiding application between the toes to prevent moisture buildup.</li>
<li>Trim toenails carefully by cutting straight across and avoiding cutting into the corners to reduce the risk of ingrown nails or wounds.</li>
<li>Choose appropriate shoes and socks that fit well, neither too tight nor too loose, and wear soft, breathable socks to reduce pressure and friction.</li>
<li>Reduce pressure on wounds or high-risk areas by avoiding prolonged walking or standing and using weight-distributing aids such as special shoes or support devices.</li>
<li>Check shoes before wearing to prevent stepping on hard objects or foreign materials that could cause wounds.</li>
<li>Perform gentle foot exercises regularly such as toe movements, ankle rotations, or foot stretches to stimulate blood circulation and promote healing.</li>
</ul>
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<h2>At what stage of wound progression is amputation necessary?</h2>
Amputation is usually the last option considered by doctors when diabetic ulcers become severe, especially with tissue necrosis, severe infection, and when other treatments such as antibiotics or revascularization procedures are no longer effective. The criteria for consideration include:
<ul>
<li>Partial tissue necrosis such as at the toes or sole, where high risk of infection exists. Doctors may consider amputating only the damaged part to reduce infection spread and complications.</li>
<li>Partially controlled infection where antibiotics or minor surgery can control the infection, and partial amputation may suffice.</li>
<li>Widespread tissue necrosis when infection spreads extensively and does not respond to antibiotics or treatment, amputation may be necessary to save life and prevent severe complications like sepsis.</li>
<li>Severe ischemia where the wound area has severe blood flow loss and cannot be treated with angioplasty or arterial bypass surgery to improve blood supply to the leg or foot, amputation may be the only way to stop wound progression.</li>
</ul>
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Managing diabetic wounds requires careful attention and meticulous care because infection or wound progression can lead to severe complications and increase overall health risks. If you or someone close to you is facing diabetic wound problems and needs standard care, you can consult the Surgical Center at Phyathai Phaholyothin Hospital, which has a team of experienced specialists and modern medical technology and equipment to provide comprehensive diabetic wound care, including treatment, prevention of wound progression, and holistic health care to relieve concerns about chronic or slow-healing diabetic wounds and help restore a good quality of life.
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Dr. Praphawan Theerasart 
Surgeon, Surgical Center 
Phyathai Phaholyothin Hospital

Diabetic ulcers often occur on the feet, especially around the tips of the toes and the ball of the foot. Let's take a look at why diabetic ulcers heal slowly, the signs that indicate the wound is infected and spreading, as well as how to care for the feet of diabetic patients to prevent the wound from worsening to the point of amputation.

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Why do diabetic wounds heal slowly? And how to care for your feet to prevent wound progression

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