Does Smoking Make Diabetic Foot Problems Worse?

Published: 18th June 2009
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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.

Much the same that I believe I have the right to make the decision to compete in the Ironman triathlon events, I also think that anyone has the right to decide to smoke. I don't personally care if you choose to smoke. Please keep in mind that the arguments against smoking that make have nothing to do with moral issues, only biological ones.

Cigarette smoke contains numerous identified chemicals and toxins that have specific detrimental 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. Many of the chemicals contained within cigarette smoke, temporarily shrink the size of the blood vessels in the heart itself. This places you at increased risk of a heart attack.

In a very similar fashion, smoking can reduce the amount of blood circulation in the feet and legs. Poor circulation in the feet and legs is a very common problem among diabetics. 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.

Not only does smoking slow down the blood flow, but it also so decreases the amount of oxygen delivered 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.

Any time a bone is fractured or has surgery, the healing process in the bone is dramatically reduced. 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. The bottom line is that smoking slows wound healing. When you develop an open diabetic foot ulcer, the white blood cells are the part of the immune system that fight off infection and the fibroblasts are the cells to grow new tissue to close 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 more time that an ulceration stays open, the more opportunity for bacteria to invade the tissue and cause the type of infection that could lead to an amputation.

Now that it is clear that cigarette smoking and slow wound healing and make it more likely that you will have a diabetic foot amputation, 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 quit only one week before surgery, their bones healed just as quickly as people that had never smoked at all.

You should know that nicotine is harmful to bone healing, wound healing, as well as diabetic foot circulation. Nicotine replacement therapies such as nicotine gum and patches are certainly better than smoking, because they contain fewer chemicals and toxins. But if possible, you should avoid smoking as well as nicotine substitutes, while healing is taking place.

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.


Dr. Christopher Segler is a published author and award winning diabetic foot surgeon. He believes that diabetic leg amputations result from inadequate patient education. He thinks doctors should take the time to necessary to prevent amputations. You can learn more by requesting your FREE report "No Leg Left To Stand On: The Secrets Insurance Companies Don't Want You To Know About Diabetic Foot Amputation" at .

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