Diabetic Wounds and Infection Surveillance

Diabetic foot wounds are dangerous because diabetes can remove two of the body’s usual protections: sensation and blood flow. Peripheral neuropathy reduces the ability to feel pressure, friction, heat, or a foreign object in a shoe. A patient may continue walking on a blister, crack, or puncture wound because it does not hurt. Peripheral arterial disease compounds the problem. Reduced arterial perfusion means less oxygen, fewer nutrients, and less effective delivery of immune cells and antibiotics to the tissue. The wound may therefore enlarge or become infected before the patient recognizes that anything is wrong. A painless wound is not necessarily a minor wound. In a patient with diabetes, absence of pain may reflect loss of protective sensation rather than healing.