Smoking cigarettes has long been known to have detrimental health effects on the body, contributing to heart disease, COPD (chronic obstructive pulmonary disease), lung cancer and early death. Smoking can also have many lesser known but just as deadly health effects on the feet. The feet are the part of the body that is farthest from the heart and the blood flow can be severely decreased by smoking, causing many effects on the feet.
Smoking elevates the levels of nicotine in the blood which causes the blood vessels to constrict or get small. Nicotine, one of the toxic components of tobacco smoke, constricts blood vessels by approximately 25 percent of their normal diameter. Because of the constriction of the vessels, decreased levels of nutrients and oxygen are supplied to the parts of the body including the skin and bones of the feet. Similarly, carbon monoxide, another toxic component in tobacco smoke, reduces oxygen flow through the body, thus reducing the supply of oxygen needed by damaged cells to regenerate and heal. Smoking contributes to developing peripheral arterial disease (PAD) in which the arteries are hardened and blood flow is further decreased to the legs and feet. This lack of blood flow can lead to delayed healing of ulcers, infections, and amputations to the lower leg.
Exposure to cigarette smoke decreases blood flow and damages skin cells and connective tissues that help maintain healthy skin. It is well known that smoking is associated with premature skin ageing and wrinkles on the face but it can do the same on the feet. The skin loses elasticity and many fine red lines are seen in the skin. Smoking tobacco decreases the ability of skin to heal and repair wounds. This is particularly evident after patients undergo surgery. Smoking reduces the moisture in the skin leading to dry skin. Dry skin can feel uncomfortable because it is less flexible, it becomes unattractive and may take on a red, flaky or scaly appearance. It is also more likely to crack or itch.
Many smokers will have thickened, dry, scaly skin on the bottom of their feet, often with painful corns and thick calluses that dramatically clear up once they stop smoking. Smoking also increases the risk of skin cancer. One study found that cigarette and pipe smokers were twice as likely as non-smokers to develop squamous cell carcinoma of the skin. The Nurses' Health Study found that nurses who smoked were also 50 percent more likely to develop squamous cell carcinoma of the skin, compared to non-smoking nurses. Tobacco smoke exposure increases the risk of developing psoriasis.
Smokers are a high-risk group under any circumstances, but particularly during and after surgery. Many dangers face smokers after surgery including longer healing times, blood clots, wounds that break open and a greater risk of infection. Perhaps the most serious threat to smokers who have foot and ankle surgery, however, is non-union or failure of the bone to mend. Smokers are four times more likely to experience non-union than non-smokers. The bone healing rates of smokers, revealed that smokers take nearly 50 percent longer to heal after surgery or a fracture than non-smokers and often the bones failed to heal at all.
Non-healing bone is very serious, they are painful, costly and time-consuming. It can take a long time to heal after surgery or a fracture leading to extended time in crutches or immobilized. In some cases, bones that fail to mend can be treated with a non-surgical bone growth stimulating machine. If the bone still does not heal it will need more surgery. Options include using metal screws or plates to stabilize the bone, external fixation or bone grafts.
Smoking can be very dangerous in those who are undergoing foot and ankle surgery because it is so detrimental to healing bone and skin. It goes without saying that surgeons prefer patients to quit smoking to improve healing. Often, smoking cessation is required before surgery and the surgery can be delayed or cancelled if the patient continues to smoke. It is critical for persons to understand the dangers of smoking – delayed bone and skin healing, bone non-union and possibly more surgery.
The effect of smoking on health especially in the feet is well known to have significant negative impact. If you are a smoker, you are encouraged to stop smoking especially if you are planning to undergo foot and ankle surgery. It is not easy to overcome a smoking/nicotine addiction however, there are many methods to assist with smoking cessation including gums, patches, e-cigarettes during the transition period, medications and many others. Contact your primary care physicians and get help. It is worth it to stop smoking to ensure healing and good functioning of your feet.
If you are a smoker and would like to quit, see your primary care (clinic) physician for assistance. You don't have to do it alone.
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• For more information email info@familyfootcentre.com or visit www.foothealthfacts.org or www.footlogix.com. To see a podiatrist visit Family Foot Centre on #45 Daffodil Avenue, Independence Highway or call 605-3668; Bahamas Surgical Associates Centre at Hill Top Medical, telephone 603-1814/5. In Grand Bahama visit Lucayan Medical Center on East Sunrise Highway or call 373-7400.
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