Patients with type 2 diabetes and surgical foot wounds: Overtrust in primary care physicians, isolation, and difficulties contemplating the future

•Patients with severe diabetic foot ulcer are often referred to the hospital too late.•Heterogeneity in health care pathways explain the delay in podiatric care.•Family support facilitates future projection.•Vulnerabilities of these patients should be evaluated.•A systematic support by a psychologist should be offered. In Europe, 27 % of patients with a podiatric complication of diabetes are referred to a specialized structure for surgery after more than 3 months’ disease progression. Our study aimed to analyze access to healthcare and future self-projection in patients with severe diabetic foot conditions. We performed a qualitative study with semi-structured interviews in patients hospitalized with diabetic foot conditions requiring surgical treatment. We collected quantitative data on the diabetes characteristics, levels of social precariousness, anxiety and depression. We conducted 13 interviews with 2 females and 11 males; mean age 62.7 years. Five had undergone surgical debridement, six toe amputation, and two mid-tarsal amputation. Most were socioeconomically deprived and/or isolated. Three discourse themes emerged: 1) heterogeneity in the care pathway, with systemic barriers, negligence or overtrust 2) relationship between social support and the ability to project oneself into the future, 3) poverty of speech. Education should emphasize the importance of prompt referral to a specialized structure after the onset of a wound. The lack of support from loved ones and social support appeared to be associated with patients’ failure to plan for their future. We advocate for a psychological evaluation and support for all these patients.