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The foot of the Diabetic Patient

Diabetic Patient is a chronic and serious disease due to a disorder in the assimilation, use and storage of sugars provided by food, leading to an abnormal increase in the level of glucose in the blood: this is hyperglycemia.

Diabetes is a public health priority, underestimated and sometimes ignored since it affects approximately 347 million people worldwide. According to the International Diabetes Federation (IDF), in 2035, diabetes will affect 592 million people, becoming one of the leading causes of disability and death worldwide. Between now and 2035, the prevalence of diabetes will increase from 8.3% to 10.1% of the world population.

In France, 3.5 million people are affected by diabetes. (2009 estimate)

Among the many complications of diabetes (kidney failure, heart attack, stroke, retinopathy, etc.), the foot is not spared. Podiatric complications are common in diabetics; serious injuries can even, in the most severe cases, lead to amputations.

Cause: Repeated, prolonged hyperglycemia and the imbalance of diabetes which damage blood vessels and nerves, especially those of the lower limbs. Note that diabetes is the leading cause of non-accidental amputations. Worldwide, a lower limb amputation is performed every 30 seconds in a diabetic patient.

The importance of caring for the feet of diabetic people…

The care of the Diabetic Patient's foot by the chiropodist-podiatrist is part of a comprehensive and multidisciplinary medical care (general practitioner, diabetologist, nurse, chiropodist-podiatrist, dermatologist, infectious disease specialist).

It includes examination of the foot and grading of podiatric risk, podiatry care, patient education, assessment of footwear and the implementation of orthotic treatment (insoles) and suitable footwear, if necessary.

Two types of disorders can occur and have serious consequences for the diabetic person's foot.

They are of the order:

  • neuropathic : nerves are damaged, particularly those in the lower limbs (feet and legs)

  • arteriopathic : the blood vessels that supply oxygen to the entire human body see their diameter decrease.

These disorders cause insensitivity in the feet, which is all the more serious because it prevents the patient from feeling the injuries or lesions that must be monitored and treated urgently.

A classification into 4 grades, according to the severity of the lesions, makes it possible to assess the level of risk:

  • Grade 0: no sensory neuropathy. The chiropodist-podiatrist has a mission of therapeutic education and prevention

  • Grade 1: isolated sensory neuropathy. The chiropodist-podiatrist encourages increased monitoring and provides treatment

  • Grade 2: sensory neuropathy associated with lower limb arteriopathy and/or foot deformity. The chiropodist-podiatrist provides regular care to prevent the clinical situation from worsening.

  • Grade 3: history of ulceration or amputation. The chiropodist-podiatrist treats and relieves, maintains the situation to prevent it from continuing to worsen.

The chiropodist-podiatrist carries out an initial Diabetic Patient assessment which will allow him, using a podiatric or other examination, to put in place a specific treatment and follow-up care.

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