Pied diabétique : comment gérer la cicatrisation de ces plaies ?

Diabetic foot: how to manage the healing of these wounds?

Aug 27, 2023

Diabetes remains a worrying health reality, manifesting itself in different forms and affecting a significant number of individuals throughout the world. In France, the year 2020, for example, recorded more than 3.5 million people pharmacologically treated for diabetes. A revealing figure which underlines the scale of this disease and the challenges it poses in terms of care. However, the consequences of diabetes are not limited to its mere presence, but can give rise to many complications such as diabetic foot sores. What are the mechanisms responsible for this complication? What does curative and preventive care consist of?

Diabetes, a disease far from trivial

Diabetes is a chronic pathology resulting from insufficient production of insulin by the pancreas (type 1 diabetes) or poor use of the insulin produced by the body (type 2 diabetes). Insulin is a hormone that helps regulate the concentration of sugar in the blood.

Unfortunately, this pathology is far from without consequences. Indeed, after several years of development, complications may appear. Here are the main ones:

  • Visual disturbances caused by diabetic retinopathy . This is damage to the retina, which is the back layer of the eye, which can cause vision loss. Other eye complications such as cataracts or glaucoma can also occur.
  • Kidney damage, called diabetic nephropathy . In this pathology, it is the small vessels present in the kidneys which are affected. In the long term, chronic kidney failure may even occur.
  • Diabetic neuropathy , which is nerve damage that can lead to symptoms like numbness, tingling, and pain, especially in the feet and hands. Diabetic autonomic neuropathies can cause digestive, cardiovascular or even urinary disorders.
  • Heart and vascular diseases . Diabetes can increase the risk of cardiovascular diseases, including heart attacks and strokes.

In addition to these many potential complications, diabetic patients also have a high risk of developing wounds in the lower limbs.

What is diabetic foot?

Diabetic foot is the most common chronic complication of diabetes . This complication occurs due to the harmful effects of diabetes on the nerves and blood vessels in the feet. The diabetic foot encompasses a range of manifestations ranging from tingling of the feet to the formation of open ulcers, thus inducing a significant risk of infection.

Its preferred location in the lower limbs stems from the interaction between the pressure generated by body weight and a general tendency to neglect the frequency of necessary care. Not without risks, untreated ulcers and infections can lead to tissue necrosis (ie the destruction of skin cells). In the most severe cases and when treatments fail, amputation may even become necessary to stop the spread of infection.

What are the mechanisms involved?

Diabetic foot results from two main causes. One of them is diabetic neuropathy . It is an alteration of the nerves which induces a loss of sensation (yet protective), causing biomechanical abnormalities. This insensitivity predisposes to the appearance of ulcerations in areas subjected to excessive pressure. People with this neuropathy thus gradually lose the ability to feel minor injuries, excessive friction, irritation... Thus, the wounds can remain unrecognized until an advanced stage, the pain no longer exercising its function of alert.

The second cause of this complication is diabetic arteriopathy . It corresponds to blood circulation problems , more particularly to peripheral arterial disease. In this disease, there is a decrease in blood flow to the injured area, which compromises the supply of oxygen and essential nutrients. A situation which, in addition to reducing its oxygenation and nutrition, hinders the healing of the ulcer. This is why people with diabetes have more difficulty healing .

The occurrence of this complication is also closely linked to the success and duration of diabetes treatment. In fact, it is estimated that 25% of people with chronic hyperglycemia will develop a diabetic foot during their lifetime.

Diabetic foot thus results from an imbalance between nutritional, restorative and defensive mechanisms.

How to treat a wound in case of diabetes?

Medical care

Foot sores in people with diabetes are considered problems that need to be treated urgently . The occurrence of certain signs should also be considered as warning signs. This is particularly the case of fever, appearance or increase in pain, change in the condition of the wound... This is a serious pathology which requires rapid medical care.

Indeed, depending on the degree of risk of ulceration, multidisciplinary monitoring involving nurses, doctors and health network professionals may prove essential. The doctor, taking into account various factors, will be able to implement the appropriate treatment. For example, in the event of an infection, antibiotic treatment may be offered. The nurse, for his part, will be able to carry out dressing repairs in the hospital or at home.

The right bandage

To achieve optimal healing , it is crucial to choose the right dressing . Moist dressings are particularly suitable, as they create and maintain an environment conducive to wound healing. Thanks to advances in research, various formulas now exist.

One of these innovative products is the Antiscar dressing. This is a liquid dressing that is particularly effective in the context of diabetic foot wounds. In fact, it supports the healing process while reducing the risk of complications. Antiscar acts by forming a protective barrier to reduce the risk of infection and protect the skin against external aggressions. Additionally, it creates a continuous flow of fluid that cleans the lesion by removing contaminants such as bacterial particles, dead cells and suspended protein molecules. This clean, hydrated and contaminant-free environment promotes cell growth and the healing process. Thus, this dressing helps to reduce healing time.

How to prevent the appearance of sores?

On a general level

First of all, daily monitoring of the feet is a crucial means of prevention. In fact, the attentive examination of the feet on a daily basis (for example after showering) makes it possible to detect early minor traumas, responsible for approximately 95% of lesions. Other simple precautions such as avoiding walking barefoot or checking shoes for foreign objects can also help avoid many problems.

Rigorous hygiene is also an essential step. For example, drying carefully after showering, focusing on the spaces between the toes, is very important. Washing the feet should be done gently. Regularly applying a moisturizer is also recommended, as this helps protect the skin from excessive dryness.

Finally, the choice of shoes is of capital importance. The goal is to opt for shoes that provide good support, therefore avoiding models that could cause excessive friction against the skin. You should also avoid shoes that are too tight, which could cause skin irritation. If necessary, therapeutic footwear may be recommended by a chiropodist, particularly for conditions such as Hallux valgus or post-operatively.

From a medical point of view

At the same time, it is strongly recommended to carry out screening for this risk , at least once a year. This screening can be carried out by a diabetologist, a GP or even a chiropodist-podiatrist.

Blood sugar control is also a key element in preventing this complication of diabetes, since prolonged hyperglycemia is a precipitating factor for diabetic foot. In this logic, regular attendance at appointments is essential. Outside of these windows, it is still important to contact your doctor if a wound appears, even if it appears small.

If necessary, nail care can be carried out by a podiatrist. Calling on this professional helps to avoid injuries while strengthening monitoring.

In short, the management of diabetic foot wounds represents a major challenge in the management of this chronic disease. However, with a combination of preventive care, medical interventions and careful monitoring, it is possible to significantly minimize the risks and potential consequences. The prevention and management of these wounds requires a holistic approach, involving the patient, health professionals as well as technological advances. It is by understanding the underlying mechanisms of the diabetic foot and implementing preventive and curative measures that it is possible to improve the health of the individuals concerned.

French public health. (November 2021). Prevalence and incidence of diabetes.

Ameli health insurance. (March 25, 2022). Complications of diabetes: the basics.

Vuorisalo S, Venermo M, Lepäntalo M. (June 2009). Treatment of diabetic foot ulcers . J Cardiovasc Surg (Torino).

Metelko Z, Brkljacić Crkvencić N. (October 2013). Prevention of diabetic foot. ActaMed Croatia.

High Authority of Health. (December 2020). Podiatry and diabetes: multi-professional monitoring.

Vidal. (July 2023). Anti-scar gel.

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