Dr's. McNamara & Richman
899 Outer Road, Suite C
Orlando, FL 32814
407-228-2838 (ph) 
407-894-5151 (fax)

If you currently have a wound on your foot and are a diabetic you are probably very perplexed as to how you got this problem.  You may have even had the wound for quite some time and are surprised by the effects and appearance of the wound or ulcer as some people refer to it once it was pointed out to you.  On this page I will descreibe to you the pathogenesis (how it started and will progress) of this very serious problem.

Diabetes is a disease process that is diagnosed by a high blood sugar level.  This leads to a build up of bad chemicals and a decrease of helpful chemicals that in combination lead to damage of the inside lining of small arteries in the feet and ankles and sometimes even the hands. 

Now, when the damage to the lining (intimal layer) of these small arteries (arterioles) occurs, the result is a decrease in blood flow to the nerves in the Dermis and Epidermis (surface skin).  Without nerves in the skin a person can not feel.  They would be described as being insensate.  Having no or reduced ability to feel is a great risk factor for the development of a foot wound or ulcer.

This is how the ulcer/wound develops.  A pressure point on the bottom or sides of the foot will get enough mechanical pressure from shoes or floor to temporarily deprive local blood flow to that site.  Once the pressure has been maintained for a minute or so the area becomes uncomfortable due to a lack of local oxygenation of the tissues.  This is painful and causes a person to shift their weight and allow local blood flow to reoxygenate the tissues that were in deficit.  In people without the ability to feel this protective pain mechanism, like diabetics with foot wounds, they are described as having a loss of 'protective sensorium'.  Board certified foot wound specialists have the tools to diagnose this problem.  If the tissue was deprived of oxygen long enough then the tissue dies.  When pressure is removed from the now dead tissue blood flow rushes into the area in a normal physiologic effect called hyperemia.  However, there is no normal, viable cell structure left to contain this blood and a hematoma results.  The blood in a hematoma of an ulcer is great food for bacteria to grow in and quickly infects the ulcer, wound of the foot.  This is when the really significant destruction of ulcer tissues takes off and can jeopardize the health of the foot, leg and even the patients life.

If you suspect that you or someone you know has a foot wound, ulcer or a loss of sensation in their feet it is of utmost importance that you follow up with a board certified diabetic wound care specialists.  General physicians, podiatrists and hospital clinics are not all equal.  Seek the care of a foot specialist with the correct credentials and the experience to guide you to health.