National Foot Health Week 2022: How to prevent diabetic foot wounds?

Impacting more than 3.5 million French people, the diabetes is a serious metabolic disease characterized by high blood sugar levels. Often under-diagnosed because it can be asymptomatic for many years, this disease is constantly on the rise and has become a major health issue: an estimated 693 million cases in 2045 worldwide (INSERM study 2019).

Among the health complications associated with diabetes, the most common is degeneration of the sensory and motor nerves in the lower limbs of the body, also known as “diabetic foot”. 15% of diabetics develop foot ulcers in their lifetimeand 85% of amputations performed in diabetic patients are due to a foot wound.

As part of the National Foot Health Week from June 13 to 18, 2022, the IHU ICAN presents the research work of Jérôme Haddad(MSc Podiatrist – Podiatrist at the Pitié Salpêtrière University Hospital) on the risks of foot ulceration in diabetic patients.

The diabetic foot: causes and consequences

According to some studies, plantar pressure is the main risk factor for a chronic foot wound in a diabetic patient. Indeed, diabetic patients with neuropathy have a thinner plantar epidermis and more rigid plantar soft tissues than non-diabetic patients, exposing the diabetic foot to skin tissue degradation that can lead to ulcer formation.

As a consequence of the metabolic abnormalities caused by diabetes, the range of motion of the foot and ankle joints is effectively reduced in diabetic neuropathic patients. This leads to significant disturbances in the function of the foot, due to abnormally high plantar pressures that can cause chronic foot ulcer. Patients with this type of ulcer have decreased physical activity, decreased sociability, increased stress levels, and a overall negative impact on their quality of life and well-being.

The number of people with diabetes is increasing dramatically worldwide over the years, so finding solutions to reduce the rate of foot ulceration associated with diabetes is essential.

How to predict and assess the risk of diabetic foot wounds?

Jérôme Haddad’s research work (MSc Podiatrist – Podiatrist at the University Hospital of Pitié Salpêtrière) focus on design and evaluation of a predictive biomarker of foot ulceration risk for a population of diabetic patients with lower extremity peripheral neuropathy, by the use of analysis tools practiced in clinical routine.

The hypothesis of this research project is that the wounds of diabetic patients are not only due to pressure, but also to the deformation in the thickness of the plantar tissue. As the neuropathy progresses, the patient’s biomechanical and structural characteristics deteriorate. The discovery of this neuropathy or diabetes often comes too late, once the wound has appeared, because despite the presence of risk factors, some patients do not necessarily have a wound.

It is therefore fundamental to identify both morphological and functional data in order to study the transition from grade 2 to grade 3 in the patient (see diagram above), and avoid a critical situation. By taking these 2 types of variables into account, the identification of a biomarker that would allow the establishment of a standard for the risk of wounds associated with neuropathy would be a major advance in the fight against this public health problem.

Jérôme Haddad’s project therefore plans to use routine clinical tools to propose a simple tool of evaluating and predicting the risk of wounds related to the diabetic foot, accessible in primary care.

How is this diabetic foot research project structured?

The project includes several study phases:

1. Observational descriptive study of skin rheology of patients grades 1, 2 and 3: In vivo and by numerical simulation,
2. Prospective observational descriptive study of grade 3 patients comparing areas with wound history and areas that remained healthy: In vivo and by digital simulation,
3. Prospective observational longitudinal analytical cohort study: monocentric study in the form of a day hospital entitled “HDJ dépistage de la neuropathie”, with prospective longitudinal monitoring of all parameters at day 1, 6 months and 1 year.

Do not hesitate to contact us if you wish to know more about the process of this study.

What are the expected results?

The tool was created for use in clinical practice, research and clinical trials.

The research project plans to explore several aspects and hypotheses, such as:

• Analysis of inter-patient kinetics(e.g. which individuals move faster than others?),
• Evaluation of the parameters over time(What evolution? What reliability of the data?),
• The discrimination of functional risk groups and groups that would allow the creation of a new functional gradation, in order to complete the usual gradation by default of baresthesia and fine tact,
• Exploration of questions such as:Will this study lead to a functional classification? A functional clustering? A biomarker? Is grade 2 heterogeneous? Can we normalize the plantar pressure to all the different variables obtained? Can we create a prediction algorithm? Is it possible to discriminate the patient who enters the risk?

Who are the actors of this project?

• Jérôme Haddad: MSc Podiatrist – Podiatrist at the University Hospital of Pitié Salpêtrière
• Pierre-Yves Rohan: Assistant Professor – Lecturer at the Institute of Human Biomechanics Georges Charpak
• Dr Georges Ha Van Hospital Practitioner: Podiatry in Diabetes at AP-HP, Assistance Publique
• Antoine Perrier Podiatrist DE: Biomechanical engineer, PhD
• Pr Agnès Hartemann: Head of the diabetology and metabolism department at the Pitié Salpetrière Hospital

How to support diabetic foot research?

This innovative research project is financed by external funds. Donations are therefore essential to accelerate medical research and improve the care of patients suffering from diabetes.

• Would you like to support this specific research project related to the diabetic foot? You can contact Francine Trocmé by e-mail at f.trocme@ihuican.org or by phone +33 (0)1 88 40 64 05.
• Would you like to support the activities of the IHU ICAN in the fight against cardiometabolic diseases? Make a donation below.

Data sources, from Jérôme Haddad’s research:
• Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet 2005
• Boulton A.J.M. et al. 2004
• Etudes Veves et al. (1992), Ahroni et al. (1999), Stess et al. (1997) et Fernando et al. (2013)
• Pirart J. et al 1977
• Chao et al., 2011
• Morag et Cavanagh, 1999, Morag et al., 1997
• Rao et al., 2011, Fernando et al. 1991
• Maluf et Mueller, 2003
• W. G. Meijer, 2001