Das diabetische Fußsyndrom

Abstract

Therapy and diagnosis of the diabetic foot syndrome are almost standardized, all procedures are well established. There are no challenges in technical dimensions. But the rate of major amputations remains unacceptably high in Germany. Because there are other causes than lack of medical knowledge, this review describes the somatologic, psychiatric, and philosophic perspectives of the problem.

Neuropathy and Diabetic Foot Syndrome

“…As described, patient care for diabetic foot syndrome is often complex. To meet these complex requirements, multidisciplinary and multi-professional teamwork is essential [ 1 , 51 , 52 , 53 ]. Moreover, interdisciplinary and cross-sectorial medical cooperation as well as the integration of non-physician healthcare professionals (diabetes advisor/diet assistant, podiatrist, orthopaedic master shoemaker) is vitally important.…”

“…Among all possible complications of diabetes mellitus type 2, DFS is the leading reason for hospitalisation. Among all diabetics the lifetime risk for developing a diabetic foot ulceration is 25% of which the majority will need amputation within four years of initial diagnosis [ 1 , 2 , 3 , 4 ]. Compared to non-diabetics the need for major amputation is about 30 to 40 times higher in patients with diabetes mellitus type 2.…”

Wundbehandlung ohne kurative Zielsetzung: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V.

“…Ein wichtiger pathophysiologischer Aspekt ist hierbei neben der arteriellen Makroangiopathie und der Polyneuropathie der resultierende sog. Leibesinselschwund [27]. Nichtabnehmbare Versorgungen, bei-spielsweise geschlossene Gipsverbände ("total contact cast") oder Filzdistanzpolsterungen, sind effektive Maßnahmen, um die Wundheilung bei Patienten mit DFU zu ermöglichen [25].…”