Can Leg Vascular Blockage Cause Frequent New Wounds in Diabetic Patients?

If there is a blockage in the blood vessels of the calf or foot, could this be a reason for the increased occurrence of new wounds?

Hello Dr.
Chou, I would like to consult with you regarding my father, who has kidney disease (not on dialysis), diabetes, a history of stroke, and vascular blockage in his calves.
He still walks daily with a cane for rehabilitation.
Recently, he developed a sore on the ball of his foot due to improper pressure (related to his stroke-related walking pattern).
The sore was a pressure injury, with no visible skin damage, but the doctor had to incise it to expedite healing.
After a month of nursing care, it healed.
However, about two months later, we discovered a similar but smaller sore on the same area of his foot.

Could the vascular blockage in his calves or feet be a reason for the increased likelihood of new sores? We are aware that vascular occlusion can slow wound healing, and both of his recent wounds have healed successfully, so my question is not about delayed healing but rather about the potential relationship between vascular blockage and the occurrence of new sores.
If there is no connection, it may simply be an issue of improper pressure application.
Thank you, Dr.
Chou.

Miss Wang, 50~59 year old female. Ask Date: 2024/07/16

Dr. Zhou Hongzhang reply Plastic Surgery

Vascular obstruction can indeed lead to new wounds (even minor injuries or contusions can cause this).
Additionally, old wounds may not heal easily.
However, there are slight differences in the common sites of wounds caused by vascular diseases compared to those caused by pressure ulcers.
It is advisable to consult a cardiology specialist to assess the condition of the vascular obstruction, or visit a general surgery outpatient clinic to evaluate the wound situation.

Reply Date: 2024/07/16

More Info

Yes, leg vascular blockage can indeed contribute to the frequent occurrence of new wounds in diabetic patients. This is primarily due to the compromised blood flow that results from vascular blockages, which can lead to several complications, including increased susceptibility to injuries and delayed healing.

In diabetic patients, the combination of neuropathy (nerve damage) and vascular issues can create a perfect storm for foot injuries. Neuropathy can diminish sensation in the feet, making it difficult for individuals to feel minor injuries or pressure points that could lead to wounds. When a diabetic patient has vascular blockages, the blood flow to the extremities is reduced, which can impair the body’s ability to heal and regenerate tissue. Consequently, even minor injuries can escalate into more significant wounds, especially if they go unnoticed due to lack of sensation.

In your father's case, the vascular blockage in his lower legs may make him more prone to developing new wounds, particularly if he is using an altered gait due to his previous stroke. The way he walks can put undue pressure on certain areas of his foot, leading to repeated injuries. This is compounded by the fact that diabetes can lead to poor circulation and slower healing times, which means that once a wound occurs, it may take longer to heal, increasing the risk of subsequent injuries in the same area.

It's also important to note that the presence of vascular disease can lead to skin changes, making the skin more fragile and susceptible to injury. This fragility, combined with the altered biomechanics of walking due to his stroke, can create a cycle where new wounds are more likely to occur.

To help manage this situation, it is essential to take proactive measures:
1. Regular Monitoring: Keep a close eye on your father's feet for any signs of new wounds, redness, or changes in skin color. Early detection is key to preventing complications.

2. Foot Care: Encourage good foot hygiene. This includes washing and drying the feet thoroughly, moisturizing to prevent cracking, and ensuring that toenails are trimmed properly to avoid ingrown nails.

3. Proper Footwear: Ensure that your father wears well-fitting shoes that provide adequate support and cushioning. Avoid shoes that are too tight or that may cause friction.

4. Blood Sugar Control: Maintaining optimal blood sugar levels is crucial in preventing complications related to diabetes. Regular monitoring and adherence to prescribed medications can help manage his condition.

5. Physical Therapy: If he is not already doing so, consider consulting with a physical therapist who can help him with gait training and strengthening exercises. This can help improve his walking pattern and reduce the risk of injury.

6. Consultation with Specialists: Given your father's history of vascular blockage, it may be beneficial to consult with a vascular specialist. They can assess the severity of the blockage and recommend treatments that may improve blood flow to the legs, potentially reducing the risk of new wounds.

In summary, yes, vascular blockage can lead to an increased risk of new wounds in diabetic patients due to compromised blood flow and altered biomechanics. By implementing preventive measures and maintaining regular medical check-ups, you can help manage your father's condition and reduce the likelihood of further injuries.

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