Minor Wound Care for Diabetic Patients

Self-Care Products and Diabetic Wounds

Within the realm of nonprescription products and devices, several carry a specific warning against use on diabetic skin. The greatest concern is with salicylic acid, which acts to intentionally create a wound. Its ability to slowly erode epidermis is useful for minor problems such as warts, corns and calluses. However, all salicylic acid products carry a strict contraindication against use by diabetic patients. This warning should be extended to various corn and callus removal devices. These products present varying degrees of danger to diabetic patients. There are "pumice stones," a type of solid rock; some are attached to contoured handles. These rocks may even be labeled "beauty stones." The patient is encouraged to intentionally abrade the skin by rubbing it with the rock in a misguided attempt to remove rough skin. The fallacy is that skin (e.g., elbows and knees) roughens in response to trauma. Thus, abrasion with a rock is counterproductive at best, and could cause serious infection in the diabetic who uses it to reduce a corn or callus. Other products to be avoided resemble vegetable graters, and are either perforated metal plates attached to a handle, or are actual files. A final group is "corn planes" which appear to be hair removal razors, except the distal end has a curved razor blade in it. The patient is instructed to draw it across the skin, removing successive layers of epidermis, much as a dermatologist uses a dermatome to remove skin prior to transplantation. These graters, files and planes should be advised against, and the diabetic patient who contemplates their use must be cautioned most strongly to see a podiatrist or a physician instead.

If a diabetic patient has an existing infection that is not located on the foot (e.g., folliculitis, carbuncle, furuncle, infected cut or scratch), he or she may be tempted to use any of the nonprescription ointments that contain antibacterial or antibiotic ingredients. These products are never to be used to treat an existing infection in any patient, and must not be used by the diabetic. Diabetic skin infections require aggressive and immediate prescription therapy, coupled with tight control of blood glucose, since hyperglycemia inhibits granulocyte activity and lymphocyte function.^[4]

If, however, the diabetic patient has an uninfected wound or minor burn, there is no specific contraindication against the use of antibiotic ointments to prevent infection. Presumably, their use might be helpful (and probably better than nothing at all). However, the patient should be urged to watch the wound closely and report to the physician at the first sign of any infection (e.g., redness, heat, inflammation, pain).

Cite this: Minor Wound Care for Diabetic Patients - Medscape - Nov 01, 2001.

Patient Information

If you are diabetic, you may find that wounds heal more slowly because diabetes reduces blood flow to specific areas, especially the feet and legs. Even worse, the nerves often do not function as they should, so you may not even know you have a foot injury. Within a short period of time, a minor foot injury can become infected, leading to gangrene, which requires an amputation.

You must be extremely careful at all times in regard to the care of your feet. You should check your feet every day, using a mirror to see the heel, sides, and sole of your foot. If you still cannot see certain spots, have another person help you. Watch for any swelling, area of redness, cuts, or bruises. Wash your feet carefully in warm water each day. Test the water in the bathtub with your elbow before placing your feet in the water. You may suffer a serious burn if you accidentally place your feet in water that is too hot. Since the diabetic foot has poor circulation and cannot detect burning temperatures, never use any heat product on the foot, such as heating pads, hot water bottles, or electric blankets.

Following the bath or shower, allow your feet to air-dry or gently pat them dry with a soft towel rather than using a forced-air blow dryer. Trim the toenails by cutting straight across, not angling them down at the edges. Trim them often enough so that no nail becomes long enough to cut an adjacent toe. You should file each nail smooth after cutting.

Never walk barefoot, whether indoors or outdoors. You may step on a tack, nail, or piece of glass and carry it in the foot for several days before detecting it. Choose house slippers with hard soles rather than thin rubber soles or fabric soles, such as moccasins. For outdoor use, avoid plastic or vinyl shoes, which are less flexible than others; canvas and leather shoes stretch better and allow the foot to breathe. New shoes should only be worn for short periods until they are broken in. Check carefully for red spots while breaking them in. You should always wear good socks (i.e., cotton) to prevent foot damage, and replace them if they develop a hole. If you try to mend them, the mended area may cause undue pressure on the foot.

Several nonprescription products normally applied to the skin for minor healthcare conditions pose special dangers to the diabetic patient and must never be used. For instance, people with plantar or common warts may choose topical salicylic acid medications or plasters that slowly dissolve the wart. However, they are not safe for the diabetic, since they create an artificial wound that may not heal. Similarly, there are several products for corn and callus removal, such as salicylic acid products, various stones and files, and extremely dangerous "corn planes" containing a razor blade. All must be avoided by the diabetic. If warts, corns or calluses bother you, make a special appointment with the physician handling your diabetic care.

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