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Smoking and Diabetic Foot Problems: Is It Really a Big Deal?

By Dr Christopher Segler

Republish: EasyPublish™ Published: 17Jun2009 Word count: 851 Viewed: 598 time(s) Get Free Content For Your Site

Let me begin with a disclaimer. I believe that everyone has a right to make their own personal decisions and choices about their health and the activities that they enjoy. For example, I personally compete in Ironman triathlons. There are people who believe that going 140.6 miles in a single day is dangerous and abusive to one's body. I disagree. Therefore, I compete.

In the same way that I believe I have the right to make a decision to compete in these events, I believe that any individual has the right to choose to smoke. I don't personally care if you choose to smoke. So keep in mind that in these discussions, the arguments against smoking that I make are not moral issues, but are strictly biological issues.

Smoking has a number of negative effects on the body. In many cases, these negative effects are compounded when you have diabetes. By discussing the various effects that smoking has on the symptoms of diabetes and specifically the lower extremity, you will be able to make a more informed decision about whether or not you choose to smoke.

It is well known that smoking is a risk factor for heart disease. So is diabetes. But when you smoke, your blood pressure and heart rate both increase. This forces the heart to work much harder. In addition, the blood vessels in the heart itself are actually constricted as a result of smoking. This places you at increased risk of a heart attack.

In much the same way, smoking decreases blood flow in the foot and leg. This also is already a problem with diabetes. But instead of causing a heart attack, smoking puts you at higher risk for poor circulation, which can lead to slow wound healing, painful cramping, and even gangrene that can lead to a diabetic foot amputation.

In addition to disrupting the blood flow, smoking decreases the delivery of life giving oxygen to the tissues. Toxic chemicals in cigarette smoke, specifically carbon monoxide, permanently block oxygen transfer sites on the red blood cells that actually carry the oxygen down to the tissues in your feet. Think of a red blood cell as a car that holds four passengers. If three of the seats are taken up by carbon monoxide, there is only one seat left for oxygen. And it stays this way until that red blood cell dies.

Bone healing is also directly affected by smoking. We know that if a patient smokes, they have a 2.7 times higher risk of not healing after bone surgery or fractures as compared to non-smokers. For this reason, I never perform elective foot surgery on a smoker.

Anyone with diabetes is at risk of developing diabetic foot ulcers or open wounds. Smoking simply slows wound healing dramatically. Whenever you have an open wound, the immune system fights off infection and the fibroblasts grow new tissue to seal up the wound. Both have to work properly in order for a wound to heal. Smoking directly affects the function of the healing cells known as fibroblasts. Smoking also weakens the immune system.

Smoking also decreases the rate at which new blood vessels can form in an area surrounding a wound. The growth of new blood vessels is necessary in order to allow tissue to heal. Simply put, no new blood flow equals no wound healing. The longer a wound stays open, the more likely it will become infected and lead to an amputation.

Given that we know smoking can decrease wound healing and increase the chances of an amputation in a diabetic, what should you do? The obvious answer is to quit smoking. However, we all know that quitting smoking is very difficult.

The good news is that you don't necessarily have to quit forever. In one study of patients that had surgery, it was shown that if a person had quit smoking for four weeks, the wound infection rates were the same in those that stopped smoking as those that had never smoked.

Another study showed that quitting smoking two weeks before surgery was effective in reducing the risk of postoperative problems to the same level as those that had never smoked.

There was also a study that evaluated bone healing and quitting smoking. In the study smokers were instructed to stop smoking one week before surgery and continue to abstain from smoking until the bone surgery healed. When they did this, they healed just as well is those that had never smoked.

Keep in mind that nicotine itself is bad for wound healing, bone healing, and a number of other diabetic foot problems. Nicotine replacement therapies including patches and gum are better than smoking. However, no nicotine during the healing period should be the goal.

You should realize that even if you have tried to stop smoking before and found it difficult, you only need to stop for a period of time to allow healing to take place. This may make it easier for you to realize that you don't have to stop smoking forever just to avoid a diabetic foot amputation.

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