Foot wounds in diabetic patients are caused by multiple factors including neuropathy, lower limb arteriopathy, increased susceptibility of diabetic patients to infections, etc. (Figure 14). This type of wound can become chronic for three main reasons: sustained pressure, superinfection of the wound and underlying ischaemia, resulting in delayed healing or even worsening of the wound.They may also be further complicated by osteoarticular infection with the risk of amputation. It is essential to explain to patients the risks involved in the management of such wounds as they are not always painful and the patient may not be aware of the seriousness of the situation.
Figure 14. Heel wound in a diabetic patient.
Thekey element of the care is the offloading of pressure from the wound. It must also be complete and permanent, making compliance often difficult, especially as healing is often lengthy. Several offloading techniques are available such as offloading shoes (Figure 15), removable plaster cast boots, etc.
In addition, new wound-healing booster dressings are now available and have been shown to be effective in neuro-ischaemic foot wounds in diabetic patients .
Figure 15. Offloading shoe for a forefoot woundin a diabetic patient.
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