Necrosis of the diabetic foot

Necrosis is a complication of the diabetic foot, itself related to diabetes. In a diabetic patient, the appearance of wounds on the feet is frequent. Associated with a loss of sensitivity, these lesions are sometimes treated late. The risk of infection, necrosis and amputation is real. What is diabetic foot necrosis? How can it be avoided? What are the possible treatments for diabetic foot? Podexpert provides an update.

The diabetic foot: what are we talking about?

Diabetic foot is a common complication of diabetes, a chronic disease related to poor blood sugar regulation. The condition affects the nervous system (sensory neuropathy) and blood systems of patients. Among the symptoms, a loss of sensitivity in the feet increases the risk of lesions and their late detection. If left untreated, these wounds can lead to infections that eventually lead to necrosis. Thus, the diabetic foot is the leading cause of amputation in France.

Diabetic foot necrosis: a complication of the diabetic foot wound

Wound is one of the main complications associated with the diabetic foot. Three types of wounds affect diabetic feet: the neuropathic wound, the ischemic wound and the neuroischemic wound. Regardless of the type of wound the patient has, necrosis is a real risk of complication. Indeed, the loss of sensation in the diabetic foot often makes the pain imperceptible to the patient. If left untreated, the wound becomes infected and the tissue necroses.

However, this podiatric risk depends on the classification grade of the diabetic patient. The higher the grade, the higher the risk of infection of an undetected wound:

• Grade 0: no loss of sensitivity;
• Grade 1: isolated sensory neuropathy;
• Grade 2: Sensory neuropathy, arteritis, diabetic foot deformity;
• Grade 3: history of amputation or ulcers.

The beginning of diabetic foot complications usually begins at grade 1.

Necrosis of the diabetic foot: how to avoid it?

Preventive actions

On a daily basis, preventive measures can be taken to limit the risk of wound necrosis:

• Daily inspection of the diabetic foot to detect signs of potential damage and ensure prompt management;
• Wash your feet with a mild soap, followed by a meticulous drying;
• Wearing shoes adapted to the morphology of the diabetic foot : discover our shoes for diabetic ;
• Annual consultation with a pedicurist-podologist to ensure foot care;
• Limiting risk factors (smoking, overweight, etc.).

Management of a diabetic foot wound

To avoid necrosis of foot tissue, the management of a wound in a diabetic patient must be rapid. The wound should be washed, dried and disinfected as soon as it is noticed. Afterwards, the wound must be protected with dressings until it is completely healed.

A large wound should also be monitored by all health care professionals involved in the care of the diabetic patient (primary care physician, diabetologist, podiatrist, etc.). Local care and antibiotic therapy are usually necessary to treat the wound and prevent necrosis of the diabetic foot. Finally, the use of an off-loading shoe is strongly recommended to avoid any stress on the wound and limit the risk of aggravation.

Discover our shoes for diabetic foot

Necrosis of the diabetic foot: how to treat it?

The treatment of diabetic foot gangrene depends on the stage of necrosis:

• Local treatment of the ulcerated tissue (detersion, antiseptic dressings, etc.);
• Antibiotic therapy to reduce diabetic foot infection;
• Surgical treatment. Surgery may range from removal of soft or necrotic tissue (debridement) to complete amputation of the infected limb.

These different treatments can be used in a complementary way to promote the recovery of the diabetic patient.

Author : Pierre Durrmann - Pedorthist and diabetic foot specialist