Évaluation et perspectives des interventions podiatriques, réalisées en contexte seul ou multidisciplinaire, sur l'ulcère plantaire diabétique et l’amputation au membre inférieur

In the context of increasing life expectancy and obesity rates as well as environmental and cultural changes, the prevalence of diabetes is on the rise, as are its inherent complications such as diabetic foot ulceration (DFU), lower extremity amputation (LEA) and higher infection risks. An efficient way to manage these complications is a multidisciplinary team (MDT) approach along with integrated foot care involving several professionals, including the podiatrist. In order to improve health-related outcomes for these persons, the objectives of this thesis are, first, to develop new knowledge to further understand the role of the podiatrist and his interventions, performed alone or in MDT context, in the management of DFU and LEA, and second, to specifically explore the possibility of new material for the prevention of bacterial colonization of UPDs, mainly associated with Staphylococcus aureus. These research projects adopt an integrated approach involving theoretical, practical and experimental domains and uses different methodological approaches such as systematic review with meta-analysis, comparative cohort study and in vitro experimental study. It has led to three scientific articles; the first two specifically address the effects of podiatrist interventions in the MDT approach on health-related outcomes (data on DFUs, LEAs and the usage of healthcare resources) and the last concerns the antibacterial efficacy of a potential material for local infection management. An integrated analysis of the research projects provides perspective on the results through the use of the framework for prevention and management of chronic diseases and the analytical framework for health-related outcomes, in relation with the latest scientific evidences on this issue. This thesis contributes to the advancement of knowledge for the management of DFUs in MDT approach including podiatrists and demonstrates that this type of clinical management can have significant impacts on LEAs, including decreasing rates of major and total LEAs and improvement of healing time and rate of DFUs. It also establishes the importance of optimizing MDT with the podiatrist. Furthermore, it puts forward the potential of an innovative biomedical material, phosphate cellulose fibers with ionic silver, to be involved in the management of local DFU infection, due to its antibacterial properties which, under laboratory conditions, have an effect comparable to similar products currently offered by the industry. In sum, what truly matters is that whether or not a DFU, with or without infection, results in LEA, the aim is to reduce the number of its occurrences and to contribute to the quality of life of the people it affects. Health professionals including podiatrists must therefore act according to best practices in MDT approach and decision-makers must mobilize the necessary resources.

Keyphrases: Amputation, Application biomédicale, Cellulose, Podiatrie, Staphylococcus aureus, Biomedical application, Silver, Diabetes, Multidisciplinary team, Podiatry, Staphyloccocus aureus, Diabetic foot ulceration