Footnotes: Nutritional Considerations For Diabetic Foot Ulcers

Hi, there. My name is Nicole Curreri, and I'm currently a fourth-year podiatry student at Temple University School of Podiatric Medicine. My co-authors, Ms. Diana Johnson, who's a nutritionist and dietician, along with Dr. Kahn, a DPM at Temple (University School of Podiatric Medicine), have worked together on an article that emphasizes the role of nutrition in healing and treating diabetic foot ulceration.

Podiatrists treat lower extremity wounds secondary to pressure, diabetes, neuropathy, trauma, etc. Most commonly, we treat diabetic foot ulcerations. About 10 to 15 percent of patients with diabetes will go on to develop a diabetic foot ulceration.

Proper nutrition plays a significant role in healing these wounds. Proper nutrition is something that every podiatrist should be addressing to their patients with these foot ulcerations. There are three primary macronutrients -- carbohydrates, proteins, and fats -- all of which play important roles in wound healing.

Protein deficiency can be seen in patients with highly exudative wounds. Therefore, a patient with diabetic foot ulceration should consume about 1.2-1.5 grams of protein per kilogram body weight daily. The other two macronutrients, carbohydrates and fats, allow wound healing to progress through the proliferation phase.

Additionally, along with meeting their macronutrient requirements, patients also need to meet their micronutrient requirements. Micronutrients include zinc, vitamin A, C, D, and E. These are important. Vitamin C, also known as ascorbic acid, helps promote fibroblast and neutrophil migration migration.

Vitamin A helps promote epithelial growth, as well as amplifies monocyte and macrophage activity in the wound, providing an anti-inflammatory effect. Literature also shows that a nutritional deficiency in zinc negatively affects the immune system and can even increase wound complications such as infection.

Last but not least, hydration is very important. It's important for a patient with a diabetic foot ulceration to stay hydrated because hydration is linked to nutrient absorption. Water also acts as a solvent for protein, carbs, vitamin and mineral transport in and out of cells via diffusion.

Goals for fluid intake in a patient with a wound are about one milliliter per kcal per day. Healthy, low-calorie beverages and nutrient-dense beverages include water, fat-free milk, and unsweetened beverages. Overall, nutrition is something that every provider should be discussing with their patients, especially those with diabetic foot ulcerations.

Recognizing nutritional deficiencies, along with educating patients on the importance of nutrition and even referring them to a nutritionist and dietitian, can not only help in healing diabetic foot ulceration but can also aid in further prevention of diabetic foot ulceration, and could even potentially improve your patient's overall health.

Therefore, when a patient comes in with a diabetic foot ulceration, it's important to have a sit-down talk with them about their nutritional status and see what they eat every day and see how you can help them change their habits to help promote wound healing.